Objective To observe the clinical efficacy of transcutaneous acupoint electrical nerve stimulation (TEAS) in treating post-stroke fatigue.Method A total of 80 patients with post-stroke fatigue were randomized into a treatment group and a control group, 40 cases in each group. The control group was intervened by conventional post-stroke treatment, while the treatment group by TEAS in addition to the intervention given to the control group. The treatment was given once a day, 7 d as a treatment course, successively for 2 treatment courses with 1-d interval between the two courses. The National Institutes of Health Stroke Scale (NIHSS) and Fatigue Severity Scale (FSS) were observed before and after the treatment.Result After 2 treatment courses, the NIHSS and FSS scores in the treatment group were significantly different from those before the treatment (P<0.05). The NIHSS and FSS scores in the treatment group were significantly different from those in the control group after 2 treatment courses (P<0.05). Conclusion TEAS can effectively alleviate the symptoms of post-stroke fatigue and promote the recovery.

Objective To investigate the feasibility of resection of internal wall for pancreatic mucinous cystic neolplasms (MCN).Methods Successive observation and cyst wall thickness measurement of the pathological sections of 24 cases with pancreatic MCN admitted in our hospital during 2008-2011.One patient with pancreatic tail MCN was treated by resection of internal wall.Results The cyst wall thicknesses of the 24 cases vary from 2 mm to more than 2 cm,and the thicknesses of fibrous envelop near pancreatic vary from 0.1 mm to 8.0 mm.The fibrous envelop thickness of 17 cases were more than 0.5 mm(70.8％,17/24).These cases could be treated with resection of internal wall.Pancreatic leakage occurred in 8 of the 24 patients (33.3％,8/24).The patient treated by resection of internal wall had no pancreatic leakage.Conclusion We consider that 70.8％ cases of pancreatic MCN could be treated by resection of internal wall to cure MCN and avoid the possibility of postoperative pancreatic fistula.

Objective To dynamically monitor the changes of peripheral blood lymphocyte subsets of renal transplant recipients and investigate the relationship between lymphocyte subsets with infection and rejection.Methods The clinical data of allogenic kidney transplantation recipients and living relative donors in the Department of Kidney Transplantation of the First Affiliated Hospital of Zhengzhou University were prospectively collected from June 2015 to December 2016.The data of lymphocyte subsets and other related indexes were obtained from renal transplant recipients and relatives of the same period.Results Sixty-four cases of living-relative donors and 351 cases of renal transplant recipients were enrolled in this study,and the recipients were divided into 3 groups:infection group (67 cases),acute rejection group (46 cases),and stable group (238 cases),according to the diagnostic criteria.There was significant difference in the concentration distribution of lymphocytes between the stable group and the control group (P<0.05).The stable frequency distribution range of the stable group was as follows (cells/μL):Lym (1 000-1 500),T (<1 500),CD4+ (<1 000),CD8+ (<1 000),B (<300),NK (100-300),CD4+/CD8+ (0.5-1.0).The number of Lym,T,CD4+,CD8+,NK and B cells in the preoperative patients was less than that in the healthy population (P<0.05);The number of Lym,T,CD4+, CD8+,B and NK cells was gradually decreased in the postoperative infection group,which was less than that in the stable group (P<0.05).After treatment the indicators gradually restored to the level in the stable group level;the number of T,CD4+,CD8+,B cells was highly correlated with infection.The number of T and CD4+ cells,and CD4+/CD8+ ratio were significantly increased in acute rejection group as compared with the stable group,and gradually decreased after the rejection was reversed.The number of T,CD4+,CD8+ cells was highly correlated with rejection.Lymphocyte subsets had a predictive effect on infection and rejection of recipients,and CD4+ cell count and CD4+/CD8+ ratio were independent risk factors.Conclusion The monitoring of lymphocyte subsets has an important clinical value in the evaluation of immune status and individual treatment of renal recipients.

Objective To investigate the effects of dextran sulfate on lung ischemia-reperfusion injury after lung transplantation in rats.Method A total of 32 male Wistar rats were subjected to unilateral left lung orthotopic transplantation.They were randomly divided two groups (n =16 each):DXS group [DXS (10 mg/kg) was given prior to the reperfusion],and the control group (the same volume of normal saline was given).After animals were sacrificed,the lung graft was harvested 2 h after reperfusion.Oxygenation indexes,wet/dry ratio (W/D),myeloperoxidase (MPO) activity,malondialdehyde (MDA) and endothelin 1 (ET-1) in the transplanted lung,and tumor necrosis factor a (TNF-α) and interleukin 8 (IL-8) in serum were measured.The lung injury scores were evaluated and complement deposition was observed.Result After 2-h reperfusion,compared to the control group,oxygenation indexes were improved significantly in DXS group (P＜0.05),but there were no significant differences in W/D between two groups.In DXS group,the activity of MPO was significantly reduced,and the contents of MDA and ET-1 in the lung tissue were significantly reduced as compared with the control group.DXS reduced the level of TNF-α and IL-8 markedly in serum (P ＜0.05).There was no significant difference in lung injury score between two groups (4.53 ± 0.46 vs.5.28 ±0.49,P＞0.05).Compared to the control group,DXS reduced the deposition of C3c (0.8 ±0.2vs1.5±0.3) andC6 (1.2±0.4vs.2.4±0.5) (P＜0.05).Conclusion Administration of DXS attenuated ischemia-reperfusion injury after lung transplantation by inhibiting complement deposition,and improved the oxygenation of the transplanted lung.This protection was associated with inhibition of inflammation and oxidation and endothelial cytoprotection.

Objective To investigate the role of protein kinase C (PKC) in reduction of hepatic ischemiareperfusion injury by CO2 preconditioning in rats.Methods Forty-eight male Wistar rats,aged 8-10 weeks,weighing 230-270 g,were randomly divided into 3 groups (n =16 each):hepatic ischemia-reperfusion injury group (group HIRI),CO2 preconditioning group (group P),and c helerythrine (CHE,a specific inhibitor of PKC) group (group CHE).The portal vein,hepatic artery and bile duct of the left lateral and median lobes of the liver were occluded for 1 h,followed by 4 h reperfusion in anesthetized rats.The rats inhaled 50％ O2-50％ N2 for 1 h during mechanical ventilation in group HIRI.In P group,the rats inhaled 50％ O2-45％ N2-5％ CO2 for 1 h during mechanical ventilation and then inhaled 50％ O2-50％ N2 and the hepatic ischemia-reperfusion injury was performed 15 min later.In group CHE,CHE 5 mg/kg was injected intraperitoneally at 10 min before mechanical ventilation,and the other procedures were similar to those previously described in P group.Before mechanical ventilation,immediately before ischemia,and at 0,1,2,3 and 4 h of reperfusion,mean arterial pressure (MAP) was recorded and arterial blood samples were obtained for blood gas analysis.At 4 h of reperfusion,the serum aspartate amino transferase (AST) and alanine amino-transferase (ALT) activities and tumor necrosis factor-α (TNF-α) concentration (by ELISA) were determined and hepatic specimens were obtained for detection of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity (by spectrophotometry),and the expression of activated caspase-3 (by immuno-histochemistry) and PKC (by Western blot) in hepatic tissues.Apoptosis index was calculated by using TUNEL.Results Compared with group HIRI,MAP,PaO2 and PaCO2were significantly increased immediately before ischemia and during reperfusion in group P,MAP and PaCO2 were increased during reperfusion and PaO2 was increased immediately before ischemia and during reperfusion in group CHE,the serum ALT and AST activities,TNF-α concentrations,MDA content and apoptosis index were decreased,and the expression of activated caspase-3 was down-regulated in P and CHE groups,and the SOD activity was increased,and the expression of PKC was up-regulated in group P (P ＜ 0.05 or 0.01),and no significant changes were found in the SOD activity and PKC expression in CHE group (P ＞ 0.05).Compared with group P,MAP was significantly increased immediately after onset of reperfusion,while decreased at 1-4 h of reperfusion,PaO2 was decreased immediately before ischemia and during reperfusion,PaCO2 was decreased at 3 h of reperfusion,the serum ALT and AST activities,TNF-α concentrations,MDA content and apoptosis index were increased,and the expression of activated caspase-3 was up-regulated,and the expression of PKC was downregulated in group CHE (P ＜ 0.05).Conclusion PKC is involved in reduction of hepatic ischemia-reperfusion injury by CO2 preconditioning in rats.

Objective To explore the role of pulmonary function analysis in drug efficacy evaluation of radiation-induced lung injury.Methods Totally 30 C57BL/6 mice were randomly divided into 3 groups:control group, radiation group and dexamethasone group.Mice in radiation group and dexamethasone group were irradiated with 20 Gy X-ray on the whole chest.Then mice in dexamethasone group was intraperitoneally injected with dexamethasone at the dose of 4.5 mg/( kg· d) for 2 weeks and then the dose was halved up to 1 month after radiation while control group and radiation group were intraperitoneally injected with 0.9%saline.One month after irradiation, pulmonary function of all the mice was tested with EMKA system.Then mice were sacrificed and pathological changes of pulmonary tissue were observed by HE staining. Furthermore, the area of alveolar cavity was measured with the Image-pro plus software.Results One month after irradiation, the pulmonary function parameters of mice in radiation and dexamethasone groups, such as mid-expiratory flow, minute volume,tidal volume,peak inspiratory flow,and peak expiratory flow,decreased obviously compared with the control group, but those parameters of the dexamethasone group decreased much less significantly than in the radiation group.The pathological changes of pulmonary tissues showed that the area of alveolar cavity of radiation group and dexamethasone group was smaller than that of the control group, but the extent of the loss of alveolar cavity area of the dexamethasone group was less than in the radiation group.Neutrophils infiltration could be found in the radiation group and dexamethasone group, but was less serious in the dexamethasone group.The result of pulmonary function analysis was coincident with pathological changes of the lung.Conclusion Dexamethasone can alleviate radiation induced pulmonary injury.Pulmonary function analysis combined with pathological observation of pulmonary tissues can effectively evaluate the efficacy of drugs in radiation induced lung injury.

Objective To evaluate the value of bedside lung ultrasound for diagnosis of acute re-spiratory distress syndrome ( ARDS) and for assessment of the severity. Methods Fifty patients of both se-xes suspected of having ARDS ( oxygenation index＜300 mmHg) and required lung CT tests and Pulse Indi-cator Continuous Cardiac Output because of their condition, aged 18-80 yr, were selected. At 24 h after entering ICU, chest CT, lung ultrasound and arterial blood gas analysis were performed to record Extravas-cular Lung Water Index ( EVLWI) and the number of B lines, and lung injury ultrasound score and oxygen-ation index were calculated. The patients diagnosed with ARDS by chest CT and lung ultrasound were divid-ed into 3 groups: mild group ( 200 mmHg＜oxygenation index≤300 mmHg) , moderate group ( 100 mmHg＜oxygenation index≤200 mmHg) and severe group ( oxygenation index≤100 mmHg) . Kappa consistency a-nalysis was used to assess the consistency between lung ultrasound and chest CT in diagnosis of ARDS. The receiver operating characteristic curves of th number of B lines, EVLWI and lung injury ultrasound score in assessing the severity of ARDS were drawn, and the area under the curve and 95％ confidence interval ( CI) , critical value, sensitivity and specificity were calculated. Results Forty-six patients were diag-nosed as having ARDS by both chest CT and lung ultrasound. There was good consistency ( Kappa value 0. 648, P＜0. 01) between chest CT and lung ultrasound in diagnosis of ARDS. There was good consistency ( Kappa value 0. 788, P＜0. 01) between lung ultrasound and chest CT in diagnosis of pulmonary consolida-tion. Lung ultrasound and chest CT were in good agreement ( Kappa value 0. 825, P＜0. 01) with each oth-er in diagnosis of pulmonary consolidation in the posterior region. Compared with mild group, the lung inju-ry ultrasound score was significantly increased, and the number of B lines was increased in moderate group, and the lung injury ultrasound score and EVLWI were significantly increased, and the number of B lines was increased in severe group ( P＜0. 05) . Compared with moderate group, the lung injury ultrasound score and EVLWI were significantly increased, and the number of B lines was increased in severe group ( P＜0. 05) . The area under the curve ( 95％ CI ) of the number of B lines in diagnosing severe ARDS was 0. 915 ( 0. 905-0. 935 ) , and the critical value, sensitivity and specificity were 15. 5, 78. 9％ and 85. 2％, respectively. The area under the curve ( 95％ CI) of lung injury ultrasound score in diagnosing severe ARDS was 0. 856 (0. 833-0. 878), and the critical value, sensitivity and specificity were 25. 5, 73. 7％ and 82. 5％, respectively. The area under the curve (95％ CI) of EVLWI in diagnosing severe ARDS was 0. 907 ( 0. 888-0. 933) , and the critical value, sensitivity and specificity were 15. 5, 73. 7％and 92. 6％, respectively. Conclusion Lung ultrasound can be used for diagnosis of ARDS and for evalu-ation of the severity of ARDS.

Objective:To compare the efficacy of single kidney transplantation for children from pediatric donors between body weight ≤15 kg and >15 kg.Methods:A retrospective review in 156 children with single donor kidney transplantation from August 2010 to December 2019 in the Kidney Transplantation Department of the First Affiliated Hospital of Zhengzhou University was conducted. The patients were classified into the small kidney group (pediatric donor body weight ≤15 kg) and the big kidney group (pediatric donor body weight >15 kg). In this study, 89 cases were concluded in the small kidney group and 67 cases were concluded in the big kidney group. The donor kidneys were obtained from 46 cases of small weight (≤15 kg) pediatric donors and 48 cases of large weight (>15 kg) pediatric donors. There were significant differences in age [1.00 (0.02 - 4.00) years vs. 10.00 (3.00-18.00) years], body weight [10.0 (3.4 - 15.0) kg vs. 35.0 (16.2- 35.0) kg], height [76 (50- 113) cm vs. 144 (67-172) cm], GFR [(31.50±7.46)ml/min vs. (36.79±7.00) ml/min], and renal length to diameter [(5.91±0.48) cm vs. (8.71±1.88) cm] between the small kidney group and the big kidney group ( P < 0.01). There was no significant difference between the two groups of donors in gender, cold/warm ischemia time and cause of death ( P>0.05). There were significant differences in age [(11.28±3.89) years vs. (13.86±3.56) years], body weight [(31.83±10.45)kg vs. (35.13±9.15) kg], and height [(130.02±28.56) cm vs. (143.97±16.59) cm] between recipients of the small kidney group and big kidney group ( P < 0.05). While there were no significant differences in preoperative serum creatinine level [(822.65 ± 135.04) μmol/L vs. (777.31 ± 165.40) μmol/L], HLA mismatch [(3.4 ± 1.4) site vs. (3.2±1.3) site], and primary disease between the two groups ( P > 0.05). The recovery of renal function, postoperative adverse events, postoperative children, and graft survival were compared between the two groups. Results:The renal function of the two groups of recipients returned to normal 3 months after operation. The perioperative complications in the small kidney group and the big kidney group mainly included renal delayed recovery [5.6% (5/89) vs. 7.5% (5/67), P=0.89], renal vascular embolization [3.4% (3/89) vs. 0, P=0.35], and acute rejection [2.2% (2/89) vs. 4.3% (3/67) , P=0.75]. The main cause of recipient death during the follow-up period was pulmonary infection [4.5% (4/89) vs. 6.0% (4/67) , P=0.68]. The postoperative small kidney group was followed up for an average of 30 (3-74) months. The survival rates of children in the small kidney group at the 1, 3 and 5 years after surgery were 96.6% (86/89), 91.0% (81/89) and 91.0%(81/89), while the transplanted renal survival rates were 92.1% (82/89), 86.5% (77/89) and 84.2% (75/89), respectively. The postoperative big kidney group was followed up for an average of 32 (4-89 ) months. The survival rates of children in the big kidney group were 95.5% (64/67), 94.0% (63/67) and 91.0%(61/67) in the first 1, 3 and 5 years postoperatively, while the graft survival rates were 92.5% (62/67), 83.6% (56/67) and 83.6% (56/67), respectively. The postoperative kidneys of two groups were fast-growing, and there was no significant difference between the small kidney group and the big kidney group in graft length to diameter [(9.63±0.31) cm vs. (9.75±0.71) cm] after 1 year ( P>0.05). Conclusions:The effect of single pediatric kidney transplantation for pediatric donor with body weight ≤15 kg is equivalent to that for pediatric donor with body weight >15 kg , which can be carried out clinically.

Objective To evaluate the effect of cardiopulmonary ultrasound in guiding volume ther-apy in the patients with sepsis-induced myocardial injury. Methods Thirty-eight patients of both sexes with septic myocardial injury, aged 28-64 yr, weighing 60-90 kg, received anti-infection, respiratory and circulatory comprehensive treatment. The patients were divided into group Ⅰ ( n=19) and group Ⅱ(n=19) by using a random number table method. Central venous pressure (CVP) was used to guide vol-ume therapy, and fluid replacement was carried out using the CVP 2-5 principle in groupⅠ. Cardiopulmo-nary ultrasound was used to guide volume therapy in group Ⅱ. Blood samples were taken before volume therapy and on 1, 3 and 5 days after volume therapy to determine the concentrations of N-terminal pro-B-type natriuretic peptide, cardiac troponin I and creatine kinase isoenzyme MB in serum. The CVP, positive fluid balance, lactic acid, central venous oxygen saturation and urine volume were recorded at 6, 24, 48 and 72 h after volume therapy. Left ventricular ejection fraction was recorded at 1, 3 and 5 days after vol-ume therapy. The length of intensive care unit stay and 28-day fatality were recorded. Results Compared with groupⅠ, the CVP and fluid positive balance were significantly decreased at each time point after vol-ume therapy, the concentration of serum N-terminal pro-B-type natriuretic peptide was decreased at 5 days after volume therapy ( P<0. 05) , and no significant difference was found in concentrations of cardiac tropo-nin I and creatine kinase isoenzyme MB in serum, lactic acid, central venous oxygen saturation and urine volume, left ventricular ejection fraction, length of intensive care unit stay or 28-day fatality rate at each time point in groupⅡ( P>0. 05) . Conclusion Cardiopulmonary ultrasound can reduce the volume of liq-uid infused, avoid fluid overload and avoid accentuating myocardial injury when used to guide volume thera-py in the patients with sepsis-induced myocardial injury.

Objective:To explore the clinical efficacy of vascular interventional therapy in children with transplantation renal artery stenosis(TRAS).Methods:From January 2013 to September 2021, retrospective analysis was performed for clinical data of 238 TRAS children.Peak systolic velocity(PSV)of transplant renal artery, interlobular artery PSV, transplant renal artery PSV/ interlobular artery PSV(post PSV ratio)and serum creatinine level before and after vascular interventional therapy and at the last follow-up were compared.Results:Six pediatric kidney transplantation recipients were diagnosed as TRAS.The median operative age was 12(9-17)years, the median postoperative time to diagnosing TRAS 4(1.7-18.0)months and the median follow-up period 6.6(2.5-8.0)years.All of them received vascular interventional therapy of percutaneous transluminal angioplasty(PTA, n=5)and stent angioplasty( n=1). The serum creatinine pre-treatment with vascular interventional therapy was significantly higher than baseline serum creatinine level at discharge(200.8±88.5)vs(75.2±27.9)μmol/L, P=0.025 and decreased to(103.8±44.7)μmol/L at Month 1 post-treatment( P=0.196)and(98.7±30.2)μmol/L at the last follow-up( P=0.115). Comparing with internal diameter of grafted renal artery anastomosis site(2.6±0.6 mm)pre-treatment with vascular interventional therapy, significant changes occurred at 24 h post-treatment(3.8±0.5 mm)and at the last follow-up(4.1±0.8 mm)(all P=0.027). In addition, PSV and post PSV ratio of transplanted renal artery at 24 h post-treatment(163±45.0 cm/s, 6.5±2.2)and at the last follow-up(184.7±80.8 cm/s, 5.4±2.0)were significantly lower than that before vascular interventional therapy(356.5±77.9 cm/s, 18.0±5.8)and interlobular artery PSV was significantly higher than that before vascular interventional therapy( P=0.024, P=0.032, respectively). During follow-ups, no restenosis or thrombosis occurred in transplanted renal arteries. Conclusions:PTA or stent angioplasty for TRAS children is technically feasible with low restenosis rate and relatively satisfactory mid/long-term outcomes.