Objective To compare the efficacy of double filtration plasmapheresis(DFPP),centrifugal therapeutic plasma exchange(cTPE)and centrifugation-filtration plasmapheresis(CFPP)in improving renal insufficiency after kidney transplantation,as well as the differences in inducing plasma exchange-related adverse reactions.Methods Clinical data from 46 patients who underwent plasma exchange after renal transplantation in our hospital were retrospectively collected,and patiens were divided into DFPP group(n=33),cTPE group(n=7)and CFPP group(n=6).Changes in peripheral blood creatinine,albumin,hemoglobin,platelets,fibrinogen levels and urine volume before and after TPE were compared and analyzed among the three groups.Results Among the DFPP group,cTPE group and CFPP group,the creatinine after TPE decreased by(31.40±25.38)%,(58.91±19.75)%and(39.44±28.64)%,respectively,with cTPE group significant-ly higher than the DFPP group(P＜0.05),but no significant differences between the DFPP group and cTPE group(P＞0.05);the urine volume after TPE increased by(49.33±30.03)%,(54.62±39.32)%and(68.89±23.00)%,showing no significant differences(P＞0.05);the hemoglobin after TPE decreased by(11.97±5.94)%,(20.17±5.75)%and(9.65±8.75)%,respectively,with the cTPE group significantly higher than the DFPP group and CFPP group(P＜0.05),but no significant difference between the DFPP group and CFPP group(P＞0.05).The platelet count after TPE decreased by(37.88±18.39)%,(24.56±12.36)%and(21.40±12.51)%,respectively,with no significant differences between the three groups(P＞0.05);the fibrinogen after TPE decreased by(0.57±0.20)%,(0.14±0.06)%and(0.26±0.22)%,re-spectively,with the DFPP group significantly higher than the cTPE group(P＜0.05),but the CFPP group had no significant difference with cTPE group or DFPP group(P＞0.05);the albumin after TPE decreased by(11.41±5.97)%,(14.67±6.52)%and(25.18±5.10)%,respectively,with cTPE group and DFPP group significantly lower than the CFPP group(P＜0.05,P＜0.001),but with no significant difference between the DFPP group and cTPE group(P＞0.05).Conclusion The effect of three plasma exchange methods varies on renal function,anemia and coagulation function of patients after kid-ney transplantation.It is necessary to consider the the patient's disease characteristics and treatment needs,as well as the laboratory′s technical conditions and plasma supply when selecting TPE methods.

Purpose: Laparoscopy is being increasingly accepted for pancreaticoduodenectomy. Stapled anastomosis (SA) is used extensively to facilitate laparoscopic pancreaticoduodenectomy (LPD); however, the incidence of anastomotic bleeding after stapled gastrointestinal anastomosis is still high. Methods: One hundred and thirty-nine patients who underwent LPD using Whipple method were enrolled in our study. We performed the SA with our reinforced method (n = 68, R method) and without the method (n = 71, NR method). We compared the clinical characteristics and anastomosis methods of patients with or without gastrointestinal-anastomotic hemorrhage (GAH), and operative parameters were also compared between the anastomotic methods. Results: Of the 139 patients undergoing LPD, 15 of them developed GAH. The clinical characteristics of patients with or without GAH were not significantly different except in the anastomotic method (P < 0.001). In the univariate logistic regression analyses, only the anastomotic method was associated with GAH. Furthermore, patients with the NR method had significantly higher incidences of GAH (P < 0.001) and Clavien-Dindo grade ≥ III complications (P < 0.001). Conclusion Our retrospective analysis showed that the SA performed with reinforced method might be a reform of SA without the reinforcement, as indicated by the lower incidence of GAH. However, further research is necessary to evaluate the utility of this reinforced method.

Objective: To summarize the incidence, clinical manifestations, diagnosis and treatment of basal cell nevus syndrome and to provide reference for clinical diagnosis and treatment. Methods : Retrospective analysis of 4 cases of basal cell nevus syndrome admitted to the General Hospital of PLA during January 2017 to January 2018 and recent cases reported in the literature. Results: In this study, 1 males and 3 females were included. The patients included a mother and her child. All 4 cases were surgically resected. Pathological reports included all keratocysts of the jaws. There has been no recurrence since follow-up. Through literature summarization and analysis, the clinical manifestations of this syndrome were found to be diverse. Typical clinical manifestations include multiple keratocysts of the jaws, multiple blepharospasms or cancers, deformities of the spine or ribs, increased brachial distance, eye diseases or special face intracranial calcification. Conclusion Basal cell nevus syndrome is an autosomal dominant genetic disorder. The clinical manifestations are diverse and the diagnosis is often overlooked. The incidence of cysts in the jaws is one of the important clinical manifestations of this syndrome. Early diagnosis and proper treatment improve patient survival and quality of life.

Objective To investigate effects of goal-directed fluid therapy on inflammatory cytokines under combined anesthesia.Methods 60 patients undergoing colorectal cancer surgery,aged 60 to 85 years old,which were classified as American Society of Anesthesiology(ASA)classⅡ~Ⅲ,were randomly assigned to Goal-directed fluid therapy group(group G,n = 30)and central venous pressure liquid management group(group C,n = 30). Life sign and BIS indexes were collected at the time points,before surgery(T1),after the start of the operation (T2),one hour after surgery(T3),after the operation(T4).Hemodynamic indexes were recorded.Two milliliter blood sample were phlebotomized for evaluation of TNF-α and IL-6 from each patient at T1,T3,T4.The infusion volume, the amount of bleeding,the operation time,anal exhaust time,and length of postoperative hospital stay were recorded. Results Comparing information between the two groups,infusion volume and colloid had an obvious decrease than that of group C(P<0.05).SVV and CVP of group G were much stable than group C.The levels of TNF-α and IL-6 of group G were lower than those of group C(P<0.01).The length of anal exhaust time and post-operative hospital stay group G were faster than that of group C(P<0.01).Conclusions Goal-directed fluid ther-apy is superior on fluid administration. It can reduce the release of IL-6 and TNF-α. It is beneficial to elderly colorectal cancer patients with hypertension.

Objective Establishing the drug?resistant Candida albicans disseminative infected mice model for new drug screening. Methods The disseminative infected mouse model was generated by intravenously injecting a clinical Drug?resistant Candida albicans strain ( CaR) to immunosuppressive ICR mice. The features of model was evaluated by clinical symptom, survival condition, fungal burden in tissue, histopathology, cytokines assay and medication. Results After infected with CaR (0 day), the death of mice started at the first day, though, compared to clinical drug sensitive strain ( CaS) infected group, the difference of mortality rate in 16?day observation period was not significant in two groups (CaR, 90?7%;CaS, 86?2%, P =0?158), mice in CaR group died faster than those in CaS group at the early stage;On the fourth day of infection, Candida albicans could be detected in the different tissues, and we found fungal burden in kidney and brain was a significant difference. The typical granuloma caused by fungal infection was the main histopathological feature observed in the kidney, brain and heart. Cytokines in renal tissue were detected by flow cytometry, The changes of IL?1α,IL?6,TNF?αand IFN?γin kidney were significant. Compared with CaS group, IL?1 and IFN?γ were significantly higher and TNF?αdecreased significantly in CaR group. The mice of groups CaR and CaS were treated with 10 mg/kg fluconazole, the mortality rates were 83?3% and 37?5%, which have a significant difference. Conclusions In this study, we successfully established a drug?resistant Candida albicans disseminative infected mice model which is potential tool for the development of new anti?infectious agent.

Objective To investigate the effects and mechanism of Sufentanil on Hep3B cell viability in liver cancer.Methods Sufentanil of different concentrations (0.01,0.1,1,5,10,1 5 μmol/L)was used to treat Hep3B cells.The changes of cell cycle,apoptosis and protein expression were detected to explore the potential mechanisms by MTT method,flow cytometry and Western blot,respectively.Results Reduced viability of Hep3B cells,arrested cell cycle in the G0/G1 phase,decreased expression of survivin protein,and increased expression of caspase-3 protein were observed with the increase of Sufentanil concentration. Conclusion Sufentanil inhibited the viability of Hep3B cells through affecting cell cycle,promoting cell apoptosis and changing protein expressions of survivin and caspase-3.

To establish a stable mouse model of systemic Candida infection and to set up related standard operation procedure .Methods ICR mice were infected with C.albicans or C.parapsilosis by tail vein injection after immunosuppres-sion by cyclophosphamide .The quality control key points included immunosuppression , strain preparation, inoculation doses and the route of inoculation .Survival analysis , bacterial loads and pathological examination were performed to evaluate the prepared model .Results The developed model showed fugal-specific lesions in multiple organs , especially in the kidneys revealed by histopathological examination .Conclusions A stable mouse model of systemic Candida albicans infection can be successfully established by following standardized operation procedure .This mouse model may provide a useful tool for studies on pathogenesis and immune defense of fungal infection and new anti-fungal drug development and so on .

Objective To investigate the effects of human umbilical cord mesenchymal stem cells (hUCMSCs)transplantation on the treatment of hypoxic-ischemic encephalopathy(HIE). Methods A total of 25 HIE patients were randomly divided into stem cell transplantation group(15 case)and control group(10 cases). The patients in transplantation group were given intravenous infusion of hUCMSCs,which isolated under sterile condition in vitro and cultured, while in control group were treated with routine drug treatment. Neurological function( American National Institutes of Health Stroke Scale( NIHSS ),Barthel index (BI)),extrapyramidal function(Unified Parkinson's disease questionnaire(UPDRS)),cognition and emotional reaction(The mini mental state examination(MMSE),the 14 item Hamilton Depression Scale(HAMD14)and HAMD24)were all assessed before and after transplantation for 14 d,90 d and 180 d respectively to evaluate the clinical efficacy of hUCMSCs transplantation. Results There was no significant difference between two groups in terms of each function before transplantation. The scores of transplantation group were all obviously improved after treatment for 14 d,90 d and 180 d compared to that of before treatment,and the therapy effect in transplantation group was significantly better than that of the control group( NIHSS:Ftime =4. 372,P=0. 031;Ftime*group =4. 175,P=0. 038;Fgroup =3. 897,P=0. 045.BI:Ftime =4. 728,P=0. 044;Ftime*group =4. 894,P=0. 037;Fgroup =4. 284,P=0. 039.UPDRS:Ftime =5. 112,P=0. 047;Ftime*group =4. 895,P=0. 045;Fgroup=3. 879,P =0. 031.MMSE:Ftime =5. 135,P =0. 039;Ftime*group =3. 213,P =0. 036;Fgroup =4. 184,P=0. 045.HAMD14:Ftime =3. 977,P =0. 049;Ftime*group =4. 587,P =0. 038;Fgroup =4. 381,P =0. 041.HAMD24:Ftime =3. 845,P =0. 033;Ftime*group =4. 125,P=0. 035;Fgroup =3. 547,P=0. 034). Conclusion Transplantation of hUCMSCs is safe and effective for treatment of HIE,which can significantly improve the neurological function,extrapyramidal function,cognition and emotion.

Objective To investigate the clinical efficacy of umbilical blood stem cell transplantation (UCBSCT) on the treatment of hepatitis B liver cirrhosis. Methods Forty-eight patients with hepatitis B liver cirrhosis were enrolled and divided into the treatment group and the control group. There were 25 patients in the treatment group , who received UCBSCT treatment based on conventional liver protection treatment and 23 patients in the control group , who received conventional liver protection treatment. The changes of liver function , coagulation function, clinical symptoms, signs and side effects were studied before the treatment and at 2, 4, 12 and 24 weeks post-treatment. Results The levels of albumin, cholinesterase, and prothrombin activity in the treatment group were higher than those before treatment and were higher than those in the control group. The parameters in the control group were not significantly changed before and after the treatment (P > 0.05). The levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin in both two groups were not significantly changed before and after the treatment (P > 0.05). After 4-week treatment,the differences on improvement of appetite , lacking in strength , abdominal distension , ascites were statistically significant in the treatment group compared with the control group (P < 0.05). No adverse reactions were observed in all groups. Conclusion UCBSCT on the treatment of hepatitis B liver cirrhosis is safe and reliable.

Objective To determine the incidence and independent risk factors of new onset posttransplantation diabetes mellitus (PTDM) and its prognostic value in medium term survival rate in heart transplant recipients.Method We performed a retrospective study on all heart transplant recipients in a single center from June 2004 to May 2012,and selected 226 patients without DM in pretransplant period with median 41-month follow-up.According to the diagnostic criteria of the American Diabetes Association (ADA) 2006 revised edition of PTDM,the selected patients were divided into PTDM (group 1) and NPTDM (group 2).Univariate analysis and logistic regression analysis were used to determine preoperative and postoperative risk factors responsible for PTDM.Kaplan-Meier method and Log rank test were used for survival analysis.Result Of the 226 patients,53 case developed DM (23.5 ％).The multivariate analysis identified the following as predictive factors for the development of PTDM:age ([OR]:1.05,95％ CI:1.01 ～2.30,P =0.012),and first-degree relatives of family history of DM ([OR]:1.90,95％ CI:1.04～4.10,P =0.032).The 1-,3-and 5-year survival rate in PTDM patients post-transplantation was 100.0％,98.0％ and 89.8％,and that in NPTDM patients was 98.2％,94.2％ and 92.4％,respectively.Log Rank test displayed no significant difference between two survival curves (P＞0.05).Conclusion PTDM is a frequent comorbidity after HT.Age and first-degree relatives of family history of DM were significant and independent risk factors for the development of PTDM during the follow-up period.By appropriate treatment,the medium-term survival rate of patients with PTDM was unaffected.