Objective To explore the protocol of tissue matching and anti-rejection therapy in highly sensitized patients (HSP). Method The panel reactive antibody (PRA), human leukocyte antigen (HLA) matching and renal transplantation outcomes of 45 HSPs were retrospectively analyzed. Results Hyperacute rejection occurred in 2 patients. Acute rejection occurred in 9 patients and reversed by anti-rejection therapy. One year patient/graft survival rate was 95.6% / 91.1% respectively. Conclusions To avoid specific antibody through HLA matching is the key point for successful renal transplantation of HSP. Antithymocyte globulin (ATG) induction therapy combined with tacrolimus, mycophenolate mofetil therapy can decrease the rate of acute rejection and prolong graft survival.

Objective To investigate the effect of cholecystokinin (CCK) on rat intestinal interstitial cells of Cajal (ICC) and the small intestinal motor function during experimentally induced acute pancreatitis (AP).Methods 20 male SD rats were divided with a random number table into model group (n =15) and control group (n =5):the 15 rats in the model group were further divided into 3 subgroups,i.e.0,20,40 μg/kg CCK sub-groups.L-omithine was intraperitoneally injected to induce pancreatitis,while normal saline was injected in the control group.24 hours after establishing AP model,CCK was administered intraperitoneally every day for 5 consecutive days.The rats were sacrificed by cervical dislocation 30 minutes after gavage with 2 ml ink.Length of the small intestine which have become black and that of the whole small intestine were measured.Intestinal sections were studied by confocal microscopy after immunofluorescence with specific antibodies.The number of positive cells was compared among the groups.Results In the control group,the number of ICC in the myenteric plexus and deep muscular plexus was (21.16 ± 3.19) /field and (17.20 ± 1.75) /field,respectively;in the AP group was (5.00 ± 1.05) /field and (4.52 ± 1.05) /field,respectively;in the AP + CCK20 group was (10.76 ± 2.09) /field and (9.84 ± 1.68) /field,respectively;in the AP + CCK40 group was (13.72 ±2.97) /field and (12.40 ± 1.81) /field,respectively;the number of ICC in the AP group were significantly lower than those in the control group (P =0.001).The ratio of transmission distance in small intestine in the control,AP,AP + CCK20,and AP + CCK40 groups was 0.71 ± 0.05,0.54 ± 0.07,0.68 ± 0.10,and 0.74 ± 0.07,respectively.The intestinal motor function was reduced in the AP group,demonstrated by shortened transmission distance,which was improved after the administration of CCK (P =0.003).Conclusions Pancreatitis can cause ICC damage,reduce ICC number,destroy ICC network and the small intestinal motor function.CCK can mitigate the damage to ICC and protect the integrity of ICC network,thereby improving intestinal motor function.

Objective To investigate the causes and preventive measures of recurrent pain after laparoscopic cholecystectomy (LC). Methods From January 2000 to January 2006,168 patients developed recurrent pain after LC. The pain was caused by non-incisional wound,postoperative complications,relapse of preoperative symptoms,cholecystitis complicated with gallbladder stones,or other diseases. The data of the cases were reviewed in this study. Results Among the cases,24 patients had neck and shoulder pain,and 5 cases complained of puncture pain; 71 cases showed consistent abdominal pain,among which 28 had bile leak; 23 developed secondary common bile duct stones,6 suffered from acute pancreatitis,and 8 had residual cholecystitis or cholecystic stones; inferior hepatic space inflammatory fluid was detected in 5 cases,duodenal bulbar ulcer in 1 case; and 32 cases suffered from paroxysmal pain in the abdominal cavity,9 of them were diagnosed as bowel hyperperistalsis,and 23 had biliary dyskinesia; 31 patients had jaundice complicated with abdominal pain,right focal dilation of the intrahepatic bile duct was detected in 7 of them,residual stones in the extra hepatic bile duct in 11 cases,ampullary carcinoma in 2 cases,carcinoma in the inferior bile duct in 1 case,and ascariasis of the biliary tract in 2 cases; two patients developed abdominal pain because of abdominal distension,and one was induced by severe nausea and vomiting. In this series,the symptoms were relieved in all of the cases,86 of them were cured by a second operation or ERCP plus EST,and the other 82 received conversational therapy. The patient was followed up for 1 to 36 months,during the period,no complications occurred. Conclusions The causes of recurrent pain after LC involve in each component of perioperation procedures.

Objective To observe the clinical curative effect of Huoxue-Zhitong decoction combined with mannitol in the treatment of swelling and pain after operation of tibiofibular fracture. Methods 86 patients with swelling after the operation of fracture of tibia and fibula were randomly divided into two groups, with 43 cases in each group. The observation group was treated with intravenous rapid infusion of mannitol, the control group was treated with Huoxue-Zhitong decoction combined with intravenous rapid infusion of mannitol. Swelling, pain visual analogue scale (VAS) score of limb of patients at 1 D and 10 d after operation, time of detumescence and acesodyne and the total efficiency of the treatment between the two groups were compared. Results The indices of the two groups mentioned above at 7 d after the operation significantly decreased, the value in the observation group was lower than the control group (1.3 ± 0.7 cm vs. 1.9 ± 0.9 cm, t=3.451; 1.5 ± 0.6 points vs. 1.9 ± 0.7 points, t=2.845; all P<0.01); The detumescence and acesodyne time of the observation group was shorter than those of the control group (8.6 ± 1.7 d vs. 9.8 ± 2.3 d, t=2.751; 5.5 ± 1.4 d vs. 6.7 ± 1.7 d, t=3.573; all P<0.01), the total efficiency in the observation group was superior to the control group, there were statistically significant differences (97.7% vs. 83.7%; χ2=4.961, P=0.026). Conclusions Huoxue-Zhitong decoction combined with mannitol is effective and safe in the treatment of swelling and pain after operation of tibiofibular fracture.

Objective To study the correlation between spiral CT(SCT)feature of non-small cell lung cancer(NSCLC)and the levels of soluble Fas(sFas)and FasL(sFasL)in serum.Methods 32 cases of NSCLC proved pathologically and examined with SCT were analyzed retrospectively.Serum level of sFas and sFasL were determined by double antibody sandwich Enzyme linked immunosorbenl assays(ELISA).The SCT features were compared with level of sFas and sFasL.Results No significance was found between serum levels of sFas and sFasL and tumor type and size(P

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Objective To observe the analgesic and sedative effects of dezocine injection on the medical thoracoscopy check -up.Methods 98 cases of patients with unexplained pleural effusion were randomly divided into sedation group(dezocine group,49 cases)and anesthesia group(local anesthesia by lidocaine,49 cases)by adopting digital expression method.Sedation group was intravenously injected with 5mg dezocine before the operation,and another 5mg dezocine was mixed with 100mL of 0.9% sodium chloride for intravenous drip,with 10mL of 2%lidocaine for local anesthesia during the operation;anesthesia group was only administered with 10mL of 2% lidocaine for local anesthesia.Verbal rating scales(VRS)results and visual analogue scales(VAS)results of the two group patients,as well as their hemodynamics and pleural reaction were recorded.Results The VAS scores of the sedation group and anesthesia group were (4.3 ±2.2)points and (2.1 ±1.9)points,respectively,VRS scores were (3.5 ± 1.1)points and (1.4 ±1.1 )points,there were statistically significant differences(t =0.415,P =0.019 and t =0.293,P =0.006,respectively).The two groups had basically similar operation duration,but the sedation group had more stable hemodynamic indexes such as maximum heart rate,systolic pressure,diastolic pressure and pleural reaction,including cough,dizziness,chest tightness,sweating,etc.Conclusion Dezocine injection can be used in medical thoracoscopy check -up and treatment,with significant analgesic effect and less adverse reaction,effectively alleviating the discomfort of thoracoscopy check -up,and improving patients′compliance and comfort,so as to enhance the success rate of thoracoscopy check -up.

Objective To observe the clinical efficacy of oral administration and external application of Yanyuxiao on acute traumatic synovitis of knee joint. Methods Totally 86 patients with acute traumatic synovitis of knee joint were randomly divided into treatment group and control group, with 43 cases in each group. The patients in the two groups were treated with conventional western medicine. Patients in the control group orally took diclofenac sodium at the same time, while patients in the treatment group received oral administration and external application of Yanyuxiao Formula for 2 weeks. The scores of pain, swelling and function of knee joint and the levels interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) of joint fluid before and after the treatment were observed. The efficacy and the recurrence rate in three months after treatment were compared. Results The scores of pain, swelling and function of knee joint of the two groups significantly decreased after treatment, and the scores of pain, swelling and function of knee joint of the treatment group in one and two weeks were lower than those of the control group (P<0.05, P<0.01). The levels of synovial fluid IL-6 and TNF-α of the treatment group were lower than those of the control group after two-week treatment (P<0.01); the total effective rate was higher than that of the control group (P<0.05). The recurrence rate of the treatment group was lower than that of the control group after discharged for 3 months (P<0.05). There were no obvious adverse reactions during the treatment period. Conclusion Oral administration and external application of Yanyuxiao Formula has definite efficacy for acute traumatic synovitis of knee joint, with good safety.

Objective To investigate the epitope of HLA class I specific antibody in the serum of highly sensitized patients (HSP). Methods The specificities and epitopes of HLA class I specific antibody from 54 HSP were monitored continually by enzyme linked immunosorbent assay (ELISA). Results 90.7 % of HSP had public epitopes of HLA class I antibody. The common public epitopes were 163E, 142 145TTKH, 83R, 71 74AQTD, 127K, 163R, 163L, 41T, 62 66RNTRN and 41 45ASPRT. The public epitopes were stable in the course of continual monitoring, and it could reflect antibody spectrum more accurately than antibody specificity analysis. Conclusion Most HSP produce HLA class I antibodies in a fairly predictable fashion. These antibodies direct against a small number of high frequency public amino acid residues with high immunogenicity. Analysis of public epitopes of HLA antibodies is very useful to predict acceptable mismatches.

Objective To explore the feasibility and efficacy of desensitization protocol for highly sensitized renal transplant patients (HSP). Methods Thirty-five HSPs ( HLA class-Ⅰ panel reactive antibody ＞50 %), including 27 patients with a positive T and/or B cell cytotoxicity crossmatch (XM) and 8 patients with a negative T and B cell XM, received plasmapheresis plus intravenous immunoglobulin (PP-IVIG)treatment. Results The positive XM was rendered negative by PP-IVIG treatment in 25 of 27 (92.6 %)HSPs, and subsequent transplantation was performed. Two patients did not receive renal transplants due to persistent positive XM. In 25 patients receiving renal transplants, no hyperacute rejection occurred. There were 8 cases of acute rejection, including 5 cases of acute humoral rejection (AHR). All rejection episodes were reversed. During a follow-up period of 52 ± 26 months, the serum creatinine levels at 12th and 24th month were 112± 18 and 130 ± 38 mol/L respectively. The 1- and 3-year graft survival rate was 96. 0 %and 80. 0 % respectively. Conclusion The desensitization therapy by PP-IVIG is effective for HSP. High rate of AHR is the major defect of this protocol. The short-term graft survival rate after this protocol is acceptable but the long-term survival rate needs to be defined.