To investigate the preventive and treated effects of protein A immunoadsorption on hyperacute rejection of highly sensitized renal transplant recipient. A total of 12 highly sensitized renal transplant recipients were selected from Department of Organ Transplantation, Zhengzhou People's Hospital between January 2006 and January 2008. Immunoadsorption treatment was performed on 12 renal transplant recipients whose panel reactive antigen was more than 50% once a week for 4-6 weeks before operation. At one day before operation, the treatment was performed once. The treatment was performed at once if the acute rejection occurred after operation. The acute rejection and adverse effect were observed. Hyperacute rejection was not occurred in any recipient. Sudden oliguria and increase of serum creatinine were occurred in two cases at several days after operation. The pathological examination showed there were inflammatory cells infiltration and edema in renal interstitial, lymphocyte aggregation around renal tubular, monocytes infiltration in capillary, endarteritis, and necrosis of small vessels in the two cases. They were diagnosed as acute rejection. Their panel reactive antibody level increased again. Average level of Class Ⅰ was 3.8% and class Ⅱ was 19.2%. Acute rejection were reversed and renal function recovered to normal by the therapy of protein A immunoadsorption and pulse therapy of high dose methylprednisolone. Average level of Class Ⅰ was 8.3% and class Ⅱ was 5.2%. One year follow-up were obtained from all recipients. Their transplanted renal function were good, which suggested protein A immunoadsorptin could eliminate antibody in recipients quickly, decrease panel reactive antibody level, and prevent acute rejection.

Objective: To compare the efficacy of paroxetine and amitriptyline in the treatment of primary fibromyalgia syndrome.Methods:46 out- and in-patients with primary fibromyalgia syndrome were randomized to two groups and treated respectively with amitriptyline 25mg~50mg per day and paroxetine 10mg~20mg per day. The Visual analogue scales(VAS) was used to evaluate the efficacy and adverse effects were recorded at baseline, month 1 and month 3.Results:In both groups pain was alleviated with statistical significance after 1 month of treatment. However the efficacy of amitriptyline and paroxetine was not statistically significant at different time points. The occurrence of adverse effects in paroxetine group was less than in amitriptyline group and the difference was statistically significant, especially dry mouth and palpitation.Conclusion:Paroxetine is as effective as amitriptyline in the treatment of primary fibromyalgia syndrome but with a better safety profile.

Objective: To assess the predictive value of coronary lfow reserve (CFR) for diagnosing coronary stenosis by transthoracic Doppler echocardiography (TTDE) in patients with hypertension.
Methods: A total of 132 patients scheduled for elective coronary angiography (CAG) due to chest pain were enrolled. The patients were divided into 2 groups: Hypertension group,n=95 and Non-hypertension group,n=37. The CRF of left anterior descending coronary artery (LAD) was measured by ATP stress TTDE at 2 days before CAG in all patients and the results were compared between 2 groups. ROC curve was conducted to assess CFR value in diagnosing LAD stenosis which was deifned by LAD luminal diameter stenosis ≥ 70% in relevant patients.
Results: The condition of LAD stenosis was similar between 2 groups (42.1% vs. 35.1%),P>0.05. The CFR value in Hypertension group was lower than that in Non-hypertension group (2.39 ± 0.86) vs. (2.87 ± 1.12),P<0.05. The ROC curve for diagnosing LAD stenosis in all patients were at 0.884 (95% CI 0.83-0.94,P<0.0001), in Hypertension group at 0.874 (95% CI 0.81-0.94,P<0.0001) and in Non-hypertension group at 0.915 (95% CI 0.82-0.98,P<0.0001). With the cut-off point of CFR ≤ 2.2, it had the diagnostic sensitivity, speciifcity and accuracy in all patients were at 80.3%, 83.5% and 80.3%; in Hypertension group were at 77.5%, 80.0% and 78.9%, in Non-hypertension group were at 69.2, 91.7% and 83.8% respectively.
Conclusion: The patients of hypertension combining chest pain had decreased CFR which implied the dysfunction of their microcirculation. CFR had the better diagnostic value for predicting the signiifcant LAD stenosis in such patients.

ObjectiveTo analyze and evaluate the responsiveness and feasibility of the quality of life instrument for patients with systemic lupus erythematos(SLE).Methods143 cases of SLE patients were measured by QLICD-SLE before and after treatment and the data were analyzed with the traditional hypothesis test and combining the effect size,standardized response mean,the relative efficiency,the standard effect size and the feasibility analysis methods.Results(1)Paired t test before and after treatment indicated that there were significant differences between after treatment and before treatment in physical(t=2.39,P<0.05) and specific module domain(t=2.22,P<0.05),while there were no significant promotion in the scores of psychological function,social function and total score after treatment.There were no significant changes of SES,SRM and CR after treatment.(2)Most patients could understand the meaning of the instrument well and spent 15-20 minutes to finish it.The rate of recovery and completed were 98.0% and 97.8% respectively.ConclusionsThe QLICD-SLE can detect clinical change of treatment with good responsiveness and feasibility.

Objective To examine the effectiveness of self-efficacy training on fluid intake in maintenance hemodialysis patients.Methods Fifty-four hemodialysis patients participated in the study.The intervention was based on Bandura's self-efficacy theory.The outcome measure was self-efficacy for managing chronic disease,the mean interdialysis weight gain,dialysis-related complications and patient satisfaction.Data were collected at baseline and 3 months after the intervention.Results The mean score of selfefficacy,the mean interdialysis weight gain,dialysis-related complications and patient satisfaction after the intervention were all statistically significant compared with those bcfore the intervention.Conclusions The study supports the effectiveness of the self-efficacy training in improving the fluid intake compliance in maintenance hemodialysis patients.So it is worth being popularized in clinic.

Objective To compare the accuracy, image quality and radiation dose between prospective ECG?gated sequential and high?pitch acquisition on 128?slice dual?source CT (DSCT) angiography in infants and children with congenital heart disease (CHD). Methods Ninety?two children with CHD from October 2011 to February 2013 were prospectively enrolled and assigned into two groups according to random number table. Forty?six patients underwent DSCT angiography with sequential mode, and the other 46 patients were examined with high?pitch mode. With surgical and/or DSA results as the standard, the diagnostic accuracy and sensitivity of the two groups for the intracardiac structures, extracadiac and coronary artery anomalies were evaluated, and the comparison was analyzed by Fisher exact test. A 5?grade scoring system was used to interpret the image quality of intracardiac structures, great vessels and the proximal and middle segments of coronary arteries. Interobserver agreement on grades of image quality was assessed by Kappa statistics. The image quality scores were compared using the Mann?Whitney U test. The Student t test or the Mann?Whitney U test was used to analyze the differences between the two groups regarding to patients' age, weight , heat rate, CT attenuation, image noise and SNR in the ascending aorta and the pulmonary trunk as well as radiation dose. Results All 92 patients successfully underwent DSCT angiography. The diagnostic accuracies of intracardiac anomalies by high?pitch group and sequential group were 95.65%(88/92) and 99.28%(274/276), showed significant difference between the two groups (P<0.05), but no significant difference in the sensitivity of intracardiac anomalies (P>0.05) .There was no significant difference in the diagnostic accuracy and sensitivity of extracadiac anomalies between the two groups (P>0.05). The diagnostic accuracies of coronary artery anomalies by high?pitch group and sequential group were 93.48%(43/46) and 100.00%(46/46), showed no significant difference between the two groups (P>0.05), but there was significant difference in the sensitivity of coronary artery anomalies (50.00%(3/6) , 100.00% (11/11)) (P<0.05). There was excellent agreement for image quality scoring of the intracardiac structures, great vessels and the proximal and middle coronary arteries between the two observers (Kappa=0.81, 0.85, 0.85, P<0.05). The median image quality scores of extracardiac great vessels were both 5.00 in high?pitch group and sequential group, and there was no significant difference between the two groups (U=981.000, P>0.05). The median image quality scores of intracardiac structures and proximal and middle segments of coronary arteries respectively by high?pitch group were 4.00 and 3.00, and 5.00 and 4.00 respectively by sequential group. The image quality of intracardiac structures (U=594.500, P<0.05) and proximal and middle segments of coronary arteries (U=397.500, P<0.05) was significantly better in the sequential group than that in the high?pitch group. There was no significant difference between the two groups in CT attenuation, noise and SNR of the ascending aorta and pulmonary trunk. The mean effective doses of the high?pitch group and the sequential group were(0.27±0.11)and(0.39±0.17)mSv, and showed significant difference between the two groups (t=4.316, P<0.05). Conclusions Both sequential and high?pitch mode of 128?slice DSCT angiography provide high accuracy for the assessment of CHD in infants and children, while the high?pitch mode, though with some image quality declined, shows further significantly lower radiation dose.

Objective To evaluate two different MRI techniques , enhanced 3D STIR SPACE and unidirectionally-encoded DWIBS MR Neurography in visualizing the brachial plexus.Methods Twenty healthy volunteers underwent MR scanning by the procedures of unidirectionally -encoded DWIBS and enhanced 3D STIR SPACE sequence of the brachial plexus.Original images were reconstructed with coronal maximum intensity projection ( MIP ).The image quality was assessed by comparing the visualization of various parts of the brachial plexus and the suppression ratio of image background.The degree of visualization was compared via χ2-test of paired data , and comparison of background suppression scores was performed using a nonparametric Wilcoxon signed rank sum test.Results The successful rate of visualizing the brachial plexus supraclavicular section ( C5-T1 ) was 84% ( 167/200 ) and 99% ( 198/200 ) , respectively, for the DWIBS and enhanced 3D STIR SPACE, and the rate for the infraclavicular section was 33%( 13/40 ) and 95% ( 38/40 ).The differences between these two techniques were statistically significant (χ2 value was 28.18 and 31.15 respectively, P <0.01).In all images, the scores of grade (Ⅰ-Ⅳ) of background suppression were 0, 0, 4 and 16 for unidirectionally-encoded DWIBS, respectively;while they were 15, 4, 1 and 0 for enhanced 3D STIR SPACE.There was significant difference between the two techniques ( Z =3.96,P <0.01).Conclusions High-quality MR neurography of the brachial plexus can be obtained using the enhanced 3D STIR SPACE sequence.It offers a complete anatomical coverage of the brachial plexus , and thus demonstrates a better capacity in depicting the anatomy of brachial plexus as compared with the unidirectionally-encoded DWIBS.

Objective The cytotoxic effect of bile acids on trophoblast and fetal development in intrahepatic cholestasis of pregnancy(ICP) were studied through the observation of ultrastructure changes and expression of epidermal growth factor receptor(EGFR) of placenta. Methods Twenty two ICP (7 with FGR and 15 without FGR) and 15 normal late pregnancies were selected. The placental ultrastructure was observed with transmission electron microscope. The expression of EGFR in placenta was determined by immunohistological method and the related quantity of EGFR mRNA was analysed by reverse transcription polymerase chain reaction (RT PCR). Results The morphological changes found in syncytiotrophoblast were the following: decrease in the number of superficial microvilli, dilatation of rough endoplasmic reticulum, tumefation or myelination of the mitochondria and abnormal distribution of chromatin. These changes of syncytiotrophoblast were more obvious in ICP with FGR. In addition, decrease in the number of capillaries and proliferation of degenerated collagenous fibrils in villi interstitium were also observed. Compared with the normal pregnancies, the expression of EGFR in placenta from ICP decreased significantly and there was no significant difference of EGFR expression in ICP with and without FGR. Conclusion Bile acids cause distinct injuries on trophoblast in a dose dependent manner and that maybe account for the decreased expression of placental EGFR in ICP.

Objective:To study the astragalus polysaccharides ( APS) effect on immune induced by influenza A virus HA2 eu-karyotic expression vector.Methods: The HA2 encoded by the DNA vaccine vector was efficiently expressed in CHO cells, as determined by reverse transcription polymerase chain reaction ( RT-PCR) and fluorescence analysis.60 rats were divided into six groups randomly,which were immunized with normal saline,pEGFP-N1,pHA2/EGFP+different dose of APS by intramuscular injection.The control sera were collected before injection.After injected the 36th day, sera were collected to analyzing IFN-γ, IL-4 and IgG level.Results:IFN-γ,IL-4 and IgG level of pHA2/EGFP+mAPS group was different from that of pEGFP-N1 group or pHA2/EGFP+lAPS group( P<0.05 ).Conclusion: Middle dose of APS could increase immune induced by influenza A virus HA2 eukaryotic expression vector.

Objective:To study whether high dose astragalus polysaccharides( APS) could affect the expression of pNS1/EGFP that included influenza A virus(IAV) non-structure protein 1(NS1) gene in the tissue.Methods:pNS1/EGFP was constructured with NS1 of IAV.Sixty Kunming mice were divided into three groups randomly.Each group of mice was injected separately with one of the following:pEGFP-N1, pNS1/EGFP and pNS1/EGFP+APS in intraperitoneal injection.The mice were injected by intramuscular injection twice with a 3-week interval between injections.The serum samples and muscle samples were obtained on day 14 and day 28 after the booster injection.Sera IL-4,sera IFN-γ,muscle caspase-3 and muscle NS1 expression were measured in ELISA,Western blot or RT-PCR.Results:There were no significant difference among the different groups in day 14 expect that IFN-γof pNS1/EGFP+APS were lower(P<0.05).IFN-γlevel or IL-4 level of pNS1/EGFP+APS were lower compared with other groups in day 28.caspase-3 of pNS1/EGFP+APS were lower compared with other groups in day 28.Conclusion:APS could increase the expression of pNS1/EGFP by decreasing the inflammation and apoptosis.