BACKGROUND: Infusion of hemopoietic stem cell from donors can promote the chimeric formation and induce specific immunologic tolerance in the allograft recipients. However, the pretreatment for cell transplantation has great toxicity to recipients. So immunosuppressant combined bone marrow infusion is introduced to anti graft versus host reaction. OBJECTIVE: Based on microchimerism, to study the security and associativity of chimera formation induced by kidney-bone marrow transplantation and immunologic tolerance.DESIGN, TIME AND SETTING: The contrast observation was performed at the department of urinary surgery, The Third People's Hospital of Zhengzhou City from January 1998 to December 2005.PARTICIPANTS: According to ABO/Rh blood type and HLA matching, 96 female patients with chronic renal failure and waiting for kidney transplantation were divided into 2 groups, In the combination group, patients received kidney combined bone marrow transplantation; the other uremia patients received the other kidney of cadavers were served as control group. The donors were 48 healthy males. METHODS: Bone marrow of donors was collected simultaneously with kidney obtain and preserved with cryoprotectant at -198 ℃ in nitrogen canister. After kidney transplantation, large dose of anti-human lymphocyte immune globulin were used for 2 weeks, then (0.9-2.5)×10~8/kg mononuclearcell was reinfused. PCR-SRY was used to identify donor derived cell-chimerism. Lymphocyte subgroup of recipients was determined by blood test; and interleukin 10 was measured by enzyme linked immunosorbent assay; in addition, the mass concentration of tumor necrosis factor α and tumor necrosis factor β was detected. MAIN OUTCOME MEASURES: Chimerism, lymphocyte subsets and cytokines were detected at various time points following transplantation. Simultaneously, the transplantation results and complication status of recipients were observed. RESULTS: The positive rate of chimera in the combination group was greater than that of the control group (P < 0.05). The 3-year follow-up showed that incidence differences of acute rejection between recipients with positive chimera and recipients with negative chimera had significance (13%, 35%, P < 0.05). There was no graft versus host disease occurred in the combination group. CONCLUSION: Kidney-bone marrow transplantation can augment chimerism in early postoperative period, and significantly reduce the rate of acute rejection, which is safe and beneficia1to induce specific immunologic tolerance in the renal allograft recipients.

Objectives To explore the optimal startup time of patient controlled intravenous analgesia (PCIA) in aged patients after thoracotomy for pulmonary lobectomy.Methods The 67 aged patients after thoracotomy for pulmonary lobectomy from January to December 2008 were randomized divided into two groups:PCIA was startup immediately after waking (instantly group) or after removal tracheal intubation (delayed group).The analgesia efficacy,cardiopulmonary function and side effect were evaluated at the awake time,12,24 and 48 hours after surgery respectively.Result Both of VAS scores at 12 hours after surgery and oxygenation index at 48 hours after surgery had significant difference (P<0.05) between the two groups.The analgesia efficacy was better in the instantly group.There was no significant difference on the duration of mechanical ventilation and side-effect rates between the two groups.No patient suffered from respiratory depression.Conclusion The early use of PCIA in aged patients after thoracotomy for pulmonary lobectomy can gain better pain control and oxygenation effect.

Objective To study the expression and significance of multidrug resistance gene (MDR1) in children with refractory epilepsy (RE). Methods Children with RE (n = 30), non-RE (n = 30) and healthy children (n=30) were collected. The expression of MDR1-mRNA in peripheral blood was analyzed by fluorescence quantitative PCR. The relationship of MDRI-mRNA with epileptic frequency and numbers of antiepileptic drugs (AEDs) were observed. Results The expression of MDR1 in RE group obviously increased when compared with that of non-RE group and healthy group (P < 0.01, P < 0.01) ; MDR1 expression was more among patients with high frequent epilepsy than patients with low frequent epilepsy (P < 0.01) ; more in patients administered with four kinds of AEDs than those with two or three kinds of AEDs (P < 0.01). Concinsions MDR1 overexpression in blood of children with RE may be linked to drug-resistant mechanism of RE. It might be used as a clinical indicator of RE.

Objective To evaluate the method of vulvar reconstruction after extended vulvectomy. Methods Retrospectively, fourteen cases of vulva carcinoma were treated by radical wide local excision, and the defects were repaired with anterolateral thigh flap and inferior pedicle rectus abdominal myocutaneous flap. After the flap was harvested, it was put on the defect through the tunnel between the donor and the recipient site and the vulvae was reconstructed. Results All the flaps were survived except 1 anterolateral thigh flap with partial necrosis. One patient was infected at the groin incision but the flap and the grafted skin were survived. The patients were treated with change of the dressing and recovered after skin grafting. All other incisions were healed with first intention. The partial necrosis area was about 4 cm?6 cm, it healed at 36 postoperative days after free skin grafting. The reconstructed vulvae were plump and elastic. It appeared like the normal vulvae and there was no contraction of the vagina. Conclusions Vulvar reconstruction with the anterolateral thigh flap and rectus abdominal flaps after the radical vulvectomy could make the patients recover easily. It produces almost normal appearance and function of the vulvae, reduces the time of would healing. The patient could have the next therapy more quickly and the quality of life improves. It has wide application value in clinics.

BACKGROUND: With the wide application of computed tomography (CT) in the screening of early lung cancer, more and more ground glass nodules (GGNs) have been found. Early intervention is helpful to improve the survival rate of lung cancer patients. Radiofrequency ablation (RFA) is an alternative option to manage primary or metastatic lung malignancies. The purpose of this study is to review the safety and clinical efficacy for lung GGN treated by RFA. METHODS: From June 2016 to March 2021, 24 patients with a total of 28 lung GGNs in our hospital underwent 28 sessions of RFA. There were 13 males and 11 females with an average age of (69.4±11.1) years. The size of GGN receiving RFA was (1.30±0.56) cm; The ablation range was (2.50±0.63) cm and ablation time was (15.00±8.68) min. RESULTS: The procedure of all RFAs went smoothly, no perioperative deaths occurred and no serious complications during the operation. The median follow-up was 25 months. One case died of myocardial infarction 2 months after operation. All 28 GGNs showed no evidence of local progression and the local control rate was 100.0%. Kaplan-Meier analysis showed that the 1-year and 2-year overall survival rates were 95.8% and 95.8%; the tumor specific survival rates were 100.0% and 100.0%, respectively. CONCLUSIONS RFA is a safe, effective and minimally invasive technique for the treatment of lung GGNs.
Aged ; Aged, 80 and over ; Female ; Humans ; Lung ; Lung Neoplasms/surgery* ; Male ; Middle Aged ; Radiofrequency Ablation/adverse effects* ; Tomography, X-Ray Computed

Ninety six female patients with chronic renal failure were randomly allocated into combination group (n =48) and control group (n =48).In combination group patients received both kidney transplantation and hematopoietic stem cell infusion,in control group patients underwent kidney transplantation only.The results showed that chronic rejection in the combination group was lower than that in the control group [2％(1/48)vs.17％ (8/48),P＜0.05)].The 1-,3-,5-and 10 y-survival rates of kidney in the combination group were 98％ (47/48),94％ (45/48),83％ (34/41) and 9/17,respectively,those in control group were 98％ (47/48),90％ (43/48),76％ (31/41) and 7/17,respectively.Infusion of donor hematopoietic stem cells can augment chimerism in early postoperative period and significantly reduce the rate of graft rejection,which is beneficial for the quality of life of the recipients.

Objective:To explore the application value of intraoperative awake combined with neuronavigation in surgery for eloquent area gliomas.Methods:Twenty patients with eloquent area gliomas, admitted to our hospital from October 2017 to June 2019, were chosen in our study. Preoperative blood oxygenation level dependent-functional MR imaging (BOLT-fMRI) was used to display the functional cortex in all patients, and diffusion tensor imaging (DTI) was used to reconstruct the peripheral fibrous tracts of the gliomas; after imaging fusion of above function structures, the data were imported into the neuronavigation system; intraoperative microscope was used to determine the functional areas in the cortex and the fiber bundle, and intraoperative awake combined with cortical stimulus was employed to determine the functional areas in the cortex again before removal of the tumors. Changes in patients' quality of life (Karnofsky performance scale, [KPS] scores) before surgery, 2 weeks after surgery, and 3 months after surgery were compared, and surgical-related complications or death were recorded.Results:Intraoperative awake combined with neuronavigation were successfully applied with the addition of cortical electrical stimulation in all 20 patients; 16 (80%) accepted total resection and 4 (20%) accepted subtotal resection. Follow-up for 2 weeks after surgery and 3 months after surgery showed that only one patient with high-grade glioma had decreased KPS scores than those before surgery, and there were no postoperative deaths or severe disabilities. As compared with KPS scores before surgery(83.02±4.76), those at 2 weeks after surgery (90.15±6.72) and 3 months after surgery (96.86±6.18) were significantly higher ( P<0.05). Conclusion:Intraoperative awake combined with neuronavigation can locate the eloquent area and fibers accurately, help neurosurgeons to resect gliomas totally in the surgery and protect patients' neuro-function.

BACKGROUND: As a new technique developed in recent years, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has the advantages of simple operation, minimal invasive, high accuracy, safety and repeatability. It has become a new standard for lung cancer diagnosis and mediastinal staging. Because small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) have different biological characteristics and treatment methods, it is very important to diagnose and differentiate the types of lung cancer in the early stage of lung cancer for the staging, treatment and prognosis of lung cancer. This article evaluated the accuracy and sensitivity of EBUS-TBNA in the diagnosis of SCLC and NSCLC. METHODS: From January 2012 to December 2018, the clinical data of 85 patients with SCLC and NSCLC who performed EBUS-TBNA in Xuan Wu Hospital CMU were retrospectively analyzed and the differences between the two groups were compared. RESULTS: 45 cases of SCLC were confirmed by immunohistochemistry and pathology. 42 cases of SCLC were diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 93.3% (42/45) and 100.0% (42/42), respectively. The positive rate of diagnosis was 48.9% (22/45) in 22 cases diagnosed by cytology, and 40 cases diagnosed by pathology, including 35 cases diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 87.5% (35/40) and 100.0% (35/35), respectively. The positive rate of diagnosis was 27.5% (11/40) in 11 cases diagnosed by cytology. The diagnostic sensitivity of EBUS-TBNA in SCLC group was significantly higher than that in NSCLC group (P<0.05). CONCLUSIONS EBUS-TBNA is more sensitive in the diagnosis of SCLC than NSCLC. As a minimally invasive technique, EBUS-TBNA can assist SCLC in early diagnosis and timely treatment.

Objective To evaluate the impact of optimizing the stroke green channel on the efficiency of acute ischemic stroke management in a county hospital. Methods A retrospective analysis of the emergency stroke green channel treatment data from Sixian People’s Hospital from May 2020 to April 2021 (before optimization of the green channel) and from May 2021 to April 2022 (after optimization of the green channel) was conducted. The rates of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) patients, as well as door-to-needle time (DNT), door-to-puncture time (DPT), and the modified Rankin scale (mRS) scores of patients three months post-treatment before and after the optimization of the stroke green channel were compared. Results Within one year before and after optimization of the green channel, the number of acute visits for ischemic stroke was 3 143 and 2 623, respectively. Before optimization, 84 and 51 underwent IVT and MT, respectively. After optimization of the green channel, the ratios of patients underwent IVT (n＝215) and MT (n＝103) significantly increased, and both DNT and DPT were significantly shortened (P＜0.000 1); the proportion of MT patients with an mRS score of 0-2 at 3 months post-discharge significantly increased (46/99 vs 13/46, P＝0.038). Conclusion After optimizing the green channel at Sixian People’s Hospital, the efficiency of stroke treatment has significantly improved, and the patients’ prognosis improved.

Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.