Objective To describe the experiences when different methods were used to treat early-onset antibody-mediated rejection (AMR) after kidney transplantation.Methods The clinical data of 42 recipients who experienced early-onset acute AMR after kidney transplantation in our department from Jan.2010 to Apr.2016 were retrospectively analyzed.The recipients were divided into 3 groups based on different strategies against AMR:group A (plasma exchange with intravenous immunoglobin);group B (bortezomib solo),and group C (combination of bortezomib and sirolimus).Results All the AMR episodes were diagnosed by kidney biopsy 9-27 days after transplantation.The AMR reversal rate in groups B and C was significantly higher than that in group A (100％ versus 60.00％,P=0.034;100％ versus 60.00％,P=0.007).The AMR recurrence rate in groups B and C was significantly lower than that in group A (0 versus 41.67％,P =0.035;0 versus 41.67％,P =0.007).The recipient survival rate was 100％ in all the three groups.There were 11 graft losses in group A,and none in group B or C.The graft survival rate in group B at 6 months,1 year and 3 years was significantly higher than in group A (100％ versus 60.00％,P =0.034;100％ versus 55.00％,P =0.021;100％ versus 50.00％,P =0.013).The graft survival rate in group C at 6 months and 1 year was significantly higher than in group A (100％ versus 60.00％,P =0.007;100％ versus 55.00％,P =0.003).There was no significant difference in AMR reversal rate,AMR recurrence rate and graft survival rate between groups B and C.There was no significant difference in incidences of infection,hyperlipidemia and bone marrow suppression among the three groups.The incidence of diarrhea in groups B and C was significantly higher than in group A (50.00％ versus 0,P =0.001;42.86％ versus 0,P =0.001).The incidence of peripheral neuritis in group B was significantly higher than in group A (25.00％ versus 0,P =0.02),but similar to group C.There was no significant difference in average serum creatinine level among three groups within 1 year after treatment (P＞ 0.05).Antibodies against human leukocyte antigen (HLA) and donor specific antibodies were detected in all the 42 recipients before treatment.The negative conversion ratio of panel reactive antibody (PRA) in group A was significantly lower than in groups B and C (10.00％ versus 87.50％,P＜ 0.001;10.00％ versus 92.86％,P ＜ 0.001).The PRA recurrence rate in group A was significantly higher than in groups B and C (85.00％ versus 37.50％,P＜0.001;85.00％ versus 0,P＜0.001),while that in group B was significantly higher than in group C (37.50％ versus 0,P =0.014).The ratio of Treg in peripheral blood at 3-12 month after treatment in group C was significantly higher than in groups A and B (P＜0.05).Conclusion Treatment for early-onset AMR after kidney transplantation based on bortezomib might be an effective and safe strategy.Graft longterm survival might benefit from the combination of bortezomib and sirolimus.

Objective To discuss the efficiency and safety of conversion from tacrolimus(Tac)to cyclosporine A(CsA) in patients with new onset diabetes after transplantation (NODAT).Methods The glucose metabolism parameters and related clinical indicators in 45 Tac treated renal transplantation recipients who developed NODAT were retrospectively analyzed.The oral immunosuppressive strategy was Tac + mycophenolate mofetil (MMF) + prednisone(Pred).Results 32 cases were converted to CsA whereas 13 patients stuck to Tac.After conversion,fasting plasma glucose (FPG)decreased from(8.2 ± 2.7)mmol/L to(5.9 ± 1.2)mmol/L(P ＜ 0.01)and HbA1c level decreased from (7.0 ± 0.9) ％ to (6.1 ± 0.7) ％ (P ＜ 0.05).The level of FPG and HbA1c was lower in the conversion group than in the control group(P ＜ 0.05).During the 1-year follow-up,the curative rate of NODAT was 53.1％ (17/32) in the conversion group while it was 0％ in the control group.No acute rejection happened after the conversion.There was no obvious change in renal function.The 1-year survival rate of patient and the transplanted kidney was 100％.Blood pressure and lipid levels were stable after the conversion.Conclusion Conversion from Tac to CsA is a simple and effective strategy to improve glucose metabolism in renal transplantation recipients with NODAT.

Objective To investigate the expression of presenilin-2(PS2) and glutathione S transferase ?(GST?) and their role in the prognosis and therapy of infiltrating ductal breast carcinoma. Methods The expression of PS2 and GST? in tumor tissues from 210 patients with infiltrating ductal breast carcinoma confirmed by pathologic examination and treated with modified radical mastectomy was examined by using LSAB immunohistochemical method. Results The expression rate of PS2 was 49.5%(104/210) and the expression rate of GST? was 48.1%(101/210). The grade of the postoperative 5-year survival rate and 10-year survival rate in four groups of 210 patients, from high to low, was the group 1 (PS2 positive expression/GST? negative expression), the group 2 (PS2 positive expression/GST? positive expression), the group 3 (PS2 negative expression/GST? negative expression) and the group 4 (PS2 negative expression/GST? positive expression). Conclusion The prognosis of the group 1 is the best, the group 2 better, the group 3 good and the group 4 the worst. The results suggest that reasonable use of endocrinotherapy and chemotherapy in infiltrating ductal breast carcinoma is necessary.

Objective To investigate the effect of HO-1 on acute rejection after orthotopic liver transplantation (OLT) in rats. Methods Taking dark agouti (DA) rats as donors and Lewis rats as recipients, OLT was performed. Before OLT, the DA rats and Lewis rats were matched in pairs, and divided into control group, ZnPP group and CoPP group, the paired rats of which intraperitoneally received normal saline, 20 mg/kg ZnPP and 5 mg/kg CoPP respectively 24 h before OLT. Ten pairs of rats were in each group. On day 3 or 7 after OLT, recipient rats were killed, then blood sample and liver specimen were collected. Plasm levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), albumin (ALB) were measured; HE staining and MPO staining were performed; The expression of HO-1 was detected by the fluorence real time RT-PCR. Results On day 3 and 7 after OLT, AST, ALT and TBIL showed significant statistical significance among the three groups; ALB was highest in CoPP group, then in control group, lowest in ZnPP group. On day 3 after OLT, control group had acute rejection of degree one to degree two, ZnPP group had acute rejection of degree two; CoPP group mainly had acute rejection of degree one; On day 7 after OLT, control group mainly had acute rejection of degree two; ZnPP group had acute rejection of degree two to degree three; CoPP group had acute rejection of degree one to two. The expression of HO-1 was highest in CoPP group, then control group, and lowest in ZnPP group. Conclusion The expression of HO-1 in OLT with acute rejection in rats can palliate the acute rejection.

Objective To investigate the clinical application of scalp nerve block combined with target-controlled infusion in neurosurgical anesthesia.Methods 40 adult patients undergoing frontotemporal craniotomies were randomly divided into the ropivacaine scalp nerve block group (group R) and control group (group C).The patients in group R received scalp nerve block with 0.5％ ropivacaine before induction while those in group C didnt.We used propofol and remifentanil in target-controlled infusion and atracurium in constant infusion to maintain anesthesia.The heart rate(HR),mean arterial pressure (MAP),bispectral index (BIS) of different time,usage of propofol and remifentanil,extubation time,visual analogue scale,and complication were recorded.Results Both groups had stable hemodynamics.The usage of remifentanil in group R was less than that of group C (t =11.10,P ＜ 0.01).The difference of extubation time,usage of propofol,and incidence of complications were not statistically significant (P ＞ 0.05).The difference of visual analog scale (VAS) (2 hour and 6 hour after operation) was statistically significant (t =5.02,4.60,P ＜0.O1).Conclusions Scalp nerve block combined with target-controlled infusion is simple with less usage of remifentanil and better analgesic effect.

ObjectiveTo explore the feasibility of mediating recipient lymphocyte reaction with donor dendritic cells (DCs) in renal allograft recipients to guide individualized inmunosuppressive therapy. Methods From Jan. 2008 to Jan. 2010, 30 recipients received living related kidney transplantation were successively and divided into 2 groups according to the strategies of the correction of the dosage of immunosuppressant, 15 in each group. The strategy of immunosuppressive therapy in both groups was Tac + MMF + Pred. The correction of the dosage of immunosuppressant in experimental group was conducted by recipient lymphocyte reaction with donor DC (LR) combined with Tac and MPA blood concentration monitoring. Only blood concentration monitoring of drugs was applied in control group. Examinations of liver and renal function, blood and urine routine as well as blood sugar were done monthly for 1 year. ResultsDuring the follow-up period, the rate of acute rejection in experimental group and control group was 13. 3 ％ and 46. 7 ％ respectively (P＜0. 05) ;the rate of infection in experimental group and control group was 6. 7％ and 40. 0％ (P＜0. 05)respectively; the adverse reaction rate in experimental group and control group was 13. 3％ and 46. 7％(P＜0. 05). There was no significant difference in the serum creatinine level between the two groups at each observation point. ConclusionThe application of combined recipient LR with donor DC and blood concentration monitoring of drugs in individualized irnmunosuppressive therapy is more comprehensive and accurate.

BACKGROUND: Stromal cell-derived factor 1 (SDF1), a potential inhibitor of infection by lymphophilic HIV-1 strains, can help to block the pathway of HIV-1 invasion into the human body.OBJECTIVE: Genotype and polymorphism of SDF1-3 'A allele associated with HIV-1 infection were investigated in She Ethnic Group in the south of China so as explore the possible causes of uninfection by HIV-1 strains among this population.DESIGN: Single sample study.SETTING: Department of Biochemistry and Molecular Biology, Gannan Medical College.PARTICIPANTS: Totally 186 She Ethnic subjects without HIV-1 infection collected randomly from those whose three generations belonged to She Ethnic Group, and inhabited in Qianshan County of Jiangxi Province,Ningde area of Fujian Province and Jingning She County of Zhejiang Province, from January to December 1995.METHODS: The whole blood samples from 186 She Ethnic subjects were collected randomly, and then their genomic DNA samples were extracted respectively. Allelic polymorphism was examined by the polymerase chain reaction and restriction-fragment-length polymorphisms (PCR-RFLP).MAIN OUTCOME MEASURES: The distribution of SDF1-3'A allele in She Ethnic Group in the south of China.RESULTS: The data of 186 She Ethnic subjects entered the result analysis without any loss in the midway. The frequency of SDF1-3 'A allele in She Ethnic Group samples was 19.6%, and the allelic distribution of the gene was in accordance with Hardy-Weinberg equilibrium. No difference was found between male and female individuals.CONCLUSION: The frequency of SDF1-3 'A allele of She Ethnic Group in the south of China was similar to that of Dai Nationality in Yunnan.Based on its slow-down effect on clinical course of AIDS, the mutation of SDF1-3'A is significant in the prevention and treatment of AIDS in She Ethnic Group in the south of China.

Objective To describe the high-resolution CT(HRCT)findings of arc-welders with early pneumoconiosis and to evaluate manifestation in different course of disease.Methods Seventy-six arc-welders with a one to thirty-eight(mean,14)years history of exposure underwent CT and HRCT scanning.The extent of abnormalities were detected.The relations of age and year history of exposure were analysed in different groups.Results Thirty-eight welders(38/76,50%)showed positive characteristic findings with conventional CT.Predominant thin-section CT findings were poorly-defined centrilobular micronodules(18/76,23.7%),branching linear structure(20/76,26.3%).The mean age in group of branching linear structure[(39±9)years old]was elder than of poorly-defined centrilobular micronodules[(34±7)years old].There was no statistical difference between the two groups(t=-1.648,P＞0.05).The mean length of service at exposure in group of branching linear structure[(15±8)years]was longer than of poorlydefined centrilobular micronodules[(10±5)years].And the significant differences were showed between the two groups in the year history of exposure(t=-2.108,P＜0.05).Conclusions Poorly defined centrilobular micronodules and branching linear structures were the thin-section CT findings most frequently seen in patients with arc-welders'pneumoconiosis and the former may be one early stage characteristic finding of arc-welders'pneumoconiosis.HRCT is useful in achieving more accurate categorization of the parenchymal changes in arc-welders'pneumoconiosis.

Objective To explore the feasibility of mediating recipient lymphocyte reaction with donor dendritic cells (DCs) in renal allograft recipients. Methods Donor bone marrow monocytes (BMMCs) were isolated and cryopreserved in liquid nitrogen before kidney transplantation. At 0 day, 1month,3 month, 6 month and 9 month post-operation, CD34+ cells which were isolated from frozen BMMCs and cultured into DCs as well as the peripheral blood lymphocytes (PBLs) of donors were used as the stimulating cells to the PBLs of recipients and healthy volunteers. The number of viable DCs from frozen- and room temperature-preserved BMMCs was counted and the reactions of recipients'and healthy volunteers' lymphocytes to DCs and donor PBLs were measured. Results 6. 8 × 107BMMCs were isolated from each 10 ml of donor bone marrow on average while (4. 10 ± 0. 58) × 105CD34+ cells were isolated by magnetic active cell sorting (MACS). There was no significant difference in the isolating rate of recovered CD34+ cells at each observation point postoperatively. The percentage of viable BMMCs and CD34+ was decreased significantly at 1 month after surgery, then, decreased slowly and progressively. The decreasing rate of BMMCs was higher than CD34+. The rate of viable DCs was maintained stable (93. 2%-94. 8% ) in each group. The reactions of recipients' and healthy volunteers' lymphocytes to DCs were stronger than those to donor PBLs (P＜0. 05). The reactions of healthy volunteers' lymphocytes to DCs were maintained stable while those of recipients' were fluctuating. Conclusion Bone marrow-derived DCs are superior to PBLs in mediating long-term lymphocyte reaction after kidney transplantation due to their stable viability and stimulating ability to lymphocytes. Only once collection of a small quality of bone marrow of donors is needed to meet the demand of immune monitoring at any time after transplantation.

Objective To understand the status quo of ICU nurses career situations and its influencing factors in Shandong province. Methods A total of 247 ICU nurses were investigated by questionnaires on career condition. Results The career condition score was 79.19 ± 11.63. In addition, statistical significances were revealed by occupational career questionnaire of ICU nurses in different aspect of the scores with age, gender, working years in the ICU, access years to ICU nurses specialist, whether to participate in career training. The scores of career condition and career identity ICU nurses were different, the 40-years-older group was higher than 31-40 years group (P=0.007, P=0.005). The dimension scores of male nurses organizational commitment was higher than that of female nurses(P=0.002). The scores of career condition whose ICU working life more than 16 years were higher than those of within 5 years(P=0.013). The career condition scores of the ICU nurses with access years of specialist qualifications 7-9 years was higher than those of within 3 years(P=0.011). Conclusions The career condition score of ICU clinical nurse specialists was at a medium level, it still needs to be further improved, managers should pay attention to the different levels of nurses to provide career training, in order to promote the professional development of critical care nurses.