Objective: To observe the soluble and dispersive characteristics of Liuwei Dihuang Ultra micro power. Methods: The similarity and difference between the soluble and dispersive characteristics of two powders with HPLC atlas were observed. The contents and dissolving characteristic of target compositions Ursolic acid and Paeonol of Liuwei Dihuang powder and ultra micro powder were compared and studied. Results: At the same retaining time two powders had the same absorbent peak, but the peak values of two powders had apparent difference. the ursonic acid and paeonol in ultra micro powder were 44.55% and 7.6% higher than those of the normal powder respectively. Conclusion: After Liuwei Dihuang is broken into ultra micro power, the chemical compositions do not change but the dissolving speed and contents increase greatly.

Objective To investigate the difference in influerce of complicated diabetes on the prognosis of kidney transplantation.Methods Analyze the data of 507 times kidney transplantation and clinical tracing.Results Totally 507 patients with kidney function failure had received 539 times kidney transplantation,52 of whom were connected with diabetes[30 male,(51.4?7.1)age;22 female,(51.6?4.9)age],and 16 cases were pre-transplant,36 cases post-transplant.The other 455 cases were non-diabetes[293 male,(38.7?12.3)age;126 female,(43.5?10.1)age].The prevalence of diversified complications in the group with diabetes was all remarkably higher than the other group.There were 9 cases death in the group with diabetes,and 35 deaths in the other group after kidney transplantation;actually the mortality of diabetes group(17.3%,9/52)was 2.45 times as high as the group without diabetes(7.7%,35/455),especially in pre-transplant diabetes group.Another result was that there was no significant difference in the survival period of the dead patients in group with and without diabetes.Conclusion The possibility for the patients who,suffer from kidney function failure with diabetes to get Kidney transplantation postoperative complications is bigger compared with those without diabetes,and the prognosis is poor.To control diabetes more effectively before and after kidney transplantation perhaps can improve the prognosis of them.

Objective To investigate the value of brain natriuretic peptide(BNP)in differential diagnosis of dyspnea in renal transplant recipients.Methods A total of 25cases of renal transplant recipients,admitted from Sep.2007to Mar.2010,developing dyspnea were reviewed retrospectively.All the patients accepted ultrasoundcardiogram examination,and serum BNP was determined,at the onset of dyspnea and 48hafter symptomatic treatment.According to the International Expert consensus document on BNP in 2008,the ideal content of serum BNP was less than 100pg/ml,and once the serum BNP exceeded 400pg/ml it was considered to be a premonitory sign of to cardiac insufficiency or excessive volume loading.Based on the results of serum BNP determination,all the patients were divided into two groups.19cases with serum BNP higher than 400pg/ml were referred as the groupⅠ,while 6cases with BNP lower than 400pg/ ml were categorized as the groupⅡ.Results The serum BNP in groupⅠwas considerably elevated reaching 1893.21?350.34pg/ml. Ultrasoundcardiogram results demonstrated impaired heart function with lower left ventricular ejection fraction(LVEF)(42.38%? 6.74%).Among the 19patients with acute heart dysfunction,12were attributed to excessive fluid loading,and in 7cases it was induced by graft dysfunction complicated by severe infection.Dyspnea was ameliorated with decreased serum BNP(305.35?45.21pg/ml)and increased LVEF(55.36%?6.26%)in groupⅠ48hafter treatment for heart failure.Serum BNP in groupⅡwas 78.52?23.26pg/ml,which was much lower than that in groupⅠ.Ultrasoundcardiogram results demonstrated that the patients in groupⅡhad better LVEF (59.72%?4.92%)than that in groupⅠ.Five of the patients in groupⅡhad normal graft renal function but severe pneumonia,and in the remaining one dyspnea was caused by allergic response when anti-lymphocyte antibody was given as an induction therapy against rejection. Symptomatic treatment did not show evident effects on both BNP and LVEF in groupⅡ.Conclusions Fast detection of serum BNP is an effective index of blood volume,beneficial in the differential diagnosis of cardiac or non-cardiac dyspnea,and provides a valuable reference to the blood volume control in patients after renal transplantation.

Objective To establish TaqMan probe real‐time Fluorescent Quantitative PCR in detecting Cryptococcus neoformans genomic DNA ,and to provide important method for detection of cryptococcal meningitis .Methods According to the Cryptococcus neoformans ITS‐rDNA sequences obtained from NCBI ,specific primers and probe were designed based on the conserved sequences , a specific 114 bp fragment was amplified by primers and probe ,then recombinant plasmid was constructed .Eight different concen‐trations from 1 .42 × 10 copy/μL to 1 .42 × 10 copy/μL were used as templates by 2 μL .In the optimum reaction condition ,the sen‐sitivity ,specificity and repeatability were evaluated and standard curve was established .15 clinical cryptococcal meningitis strains i‐solated from clinical diagnosis patients were detected .Results The real‐time PCR showed high sensitivity and specificity and was a‐ble to detect 2 .84 × 102 copies of plasmid DNA .The detection sensitivity was 2 .84 × 102 copies plasmid DNA by real‐time PCR ,no amplification curve was detected with human genomic DNA ,other fungus ,bacterias and viruses .The CV of inter‐assay were 2 .86% ,1 .48% and 1 .36% respectively with excellent reproducibility .Fifteen clinical isolated strains could be detected accurately . Conclusion A method of detection of Cryptococcus neoformans DNA by real‐time PCR is established successfully with high sensi‐tivity and specificity ,and the results are stable ,could diagnose cryptococcal meningitis rapidly and early .

Objective To observe the clinical efficacy of staphylococcal protein A immunoadsorption plus nonmyeloablative chemotherapy with CD34+ autologous peripheral blood stem cell transplantation in the treatment of refractory systemic lupus erythematosus (SLE). Methods Three patients with active SLE were enrolled into this study. All patients were diagnosed with lupus nephritis by renal biopsy and poorly responded to routine therapy. Before transplantation, patients were given 6 sessions of immunoadsorption apheresis using columns of staphylococcal protein A-silica with an interval of 3 days; each session processed 3 L plasma and a total of 18 L plasma was processed over the 6 treatments. Three days following the immunoadsorption apheresis, the mobilization of stem cells was realized by intravenous cyclophosphamide at a dose of 2 g per square meter of body surface area and subcutaneous recombinant human granulocyte colony-stimulating factor (G-CSF) at a dose of 5 g per kilogram of body weight per day for 5 days. Then, peripheral blood raonoclonal cells were obtained by CS-3000 Cell Separator, and passed through the Clini Macs CD34+ cell selection device, with the final concentration of CD34+ cells being 2.6×106, 2.1×106 and 2.4×106 per kilogram of body weight respectively, and that of CD3+ cells being 3×105, 2.1×105, and 2.0×105 per kilogram of body weight, respectively, in these three patients. The conditioning regimen consisted of oral fludarabine of 50 mg/d for 5 days plus intravenous pig anti-human thymocyte immunoglobulin (ATG) at a daily dose of 90 mg/kg for 5 days. After 72-hour treatment with ATG, the frozen stem cells were infused back to the patients. Clinical manifestations and lupus-correlated immune parameters were compared in patients at baseline and after transplantation. Results Following immunoadsorption apheresis, an obvious decrease was observed in the level of serum anti-dsDNA, antinuclear antibody and IgG antibodies, while an increase in the level of serum complement 3. All patients achieved the reconstruction of hemopoiesis 2-3 days after the transplantation. Also, an apparent clinical remission was achieved with the SLEDAI score being less than 3. Six months after the transplantation, serum anti-dsDNA and antinuclear antibodies as well as urine protein were undetectable, the level of complement 3 reached the normal range, and renal function was restored. Conclusions Staphylococcal protein A immunoadsorption plus nonmyeloablative CD34+ autologous peripheral blood stem cell transplantation are effective and safe for refractory SLE, but the long-term effect remains to be connfirmed by further studies.

Objective To explore the clinical characteristics and management of kidney transplantation in the older adults.Method Forty older kidney recipients (≥60 years old) and 777 younger (18～59 years old) recipients from June 2009 to December 2012 were retrospectively reviewed to evaluate the clinical characteristics and managements.Result Of 40 older recipients,the comorbidities of diabetes and coronary artery disease in older group were higher than in the younger (25％ vs.4.9％,and 32.50％ vs.11.38％).During the first 6 months,7 older patients died,among which 4 died from severe pneumonia,2 from heart failure and 1 from pulmonary embolism.There were 31 deaths in younger group,among which 21 died from severe pneumonia,4 from heart failure,5 from cerebrovascular accident and 2 from pulmonary embolism.The mortality in the older group was higher than in the younger group (17.5％ vs.4.6％).Six-month and 3-year survival rate in the older recipients was lower than the younger recipients (81.56％ vs.95.35％,and 81.56％ vs.94.5％,respectively).Six-month graft survival rate and 3-year survival rate in the older group were also lower than in the younger group (78.75％ vs.92.02％,and 68.82％ vs.85.40％).At the 1st and 2nd year during follow-up,the serum creatinines in the older group were close to those in the younger group,while lower level was observed 3 years after transplantation in the older patients (89.38 ± 11.34 (mol/ L vs.116.57±48.68 (mol/L).Conclusion The patients with ESRD older than 60 years have more preoperative concomitant diseases and worse health status,which contribute to the complex clinical characteristics.More aggressive indication selection,sufficient pre-operative preparation,wellmatched histocompatibility and high quality of donor kidney are the key factors of successful transplantation.Optimized immunosuppressant therapy,delicate perioperative management,preventve and effective treatment of related complications are necessary to promote the survival of recipients and graft in long term.

Objective To explore the clinical characteristics and management of acute myocardial infarction (AMI) early after kidney transplantation (＜3 months).Method Five cases of AMI early posttransplantation among 122 kidney transplant recipients from June 2011 to December 2012 were retrospectively reviewed.Results Of 5 AMI patients,there were 2 cases within one week postoperatively,one case at 11 th day postoperation,and the other two at 29th day and 46th day after operation respectively.Acute left heart failure was complicated in 3 cases within first two weeks.All the AMI patients had elevated TnⅠ levels which declined subsequently.The climax of TnⅠ levels in all the 5 AMI patients were above 5 ng/mL,and more than 20 ng/mL in two AMI patients within one week.Given by symptomatic and supportive treatment,antiplatelet and anticoagulation therapies and cardioprotective medications,all the five AMI patients were improved.Low molecular heparin was additionally administrated to the 2 cases within first week according to the severe conditions.New emerged small volume of hematocele was proved by ultrasound after 3 days and low molecular heparin was ceased.All the 5 patients survived and neither thrombolysis nor percutaneous coronary intervention therapy was given to them.Conclusion In addition to general prevention against AMI in kidney recipients with high risk factors,managing anemia and hypertensiorn,and improving graft function and systematic status are also important to decrease the risk of AMI.Moreover,cardioprotective therapy including antiplatelet therapies,beta-blockers,angiotensin-converting enzyme inhibitors (ACEI)/angiotensin-2 receptor blockers and statins,which are recommended to the general population with AMI,will also profit to the kidney transplant recipients with AMI.However,aggressive intervention therapies might be more prudent to be used in this population.

Objective To investigate the relationship between the soluble LAIR-1(sLAIR-1)in the serum from recipients after transplant and graft rejection.Methods Serum sLAIR-1 level was determined by double mAb sandwich enzyme linked immunosorbent assay on 23 cases of liver transplantation and 139 cases of kidney transplantation.Results In healthy volunteers and 98 recipients with normal graft function,sLAIR-1 was detected at low level [(4.3±2.3)μg/L and(6.3±3.7)μg/L],with the difference being not significant.In 6 cases of liver acute rejection,20 cases of kidney acute rejection and 5 cases of graft loss,serum sLAIR-1 levels were increased remarkably at high 1evels [(47.2±25.9)μg/L,(36.3±14.7)μg/L,and(28.8±9.4)μg/L respectively]as compared with the two groups of healthy volunteers and the recipients with normal graft function,even peaked at 117.3 μg/L in one case of severe liver rejection.Meanwhile,in 5 cases of liver chronic rejection,27 cases of kidney chronic rejection and 6 cases under dialysis treatment.the levels of sLAIR-1 were(16.1±6.4)μg/L,(13.1±5.5)μg/L and(11.2±4.6)μg/L respectively,significantly higher than those of the healthy volunteers and the recipients with normal graft function.Conclusion sLAIR_1 was detected at high level in the recipients suffered graft acute or chronic rejection and might be a promising monitor of rejection after transplantation.

ObjectiveTo evaluate the efficacy and safety of domestic taerolimus in the manage-ment of acute rejection in renal transplantation reeipienta.MethodsA multieeneter, open and com-parative study for domestic Taerolimua and Prograf was performed. Eighty reeipienta of first allogenie renal transplantation were randomized into 2 groups: ①Experimental group (accepting Fumeixin ad-ministration, n=58) included 23 males and 35 females with the mean age of(39.1±9.6)years. ②Control group(accepting Prograf administration, n=22) included 12 males and 10 females with the mean age of(41.34±8.5)years. There was no significant difference in the volume, warm and cold is-chemia time of donor renal, age and sex of donor. All of the 80 cases accepted tacrolimus (domestic or foreign made, at the dose of 0. 10～0. 15 mg·kg-1·d-1 , q 12 h) treatment that combined with MMF and prednisone posttransplantation. Tacrolimus CO was aimed to 8-12 ng/ml in the first 60 days and 5-10 ng/ml later. The dose of MMF was according to the rule of each transplantation center based on the following recommendation: 1.5-2.0 g/d for the weight above 70 kg, 1.5 g/d for the weight 50-69 kg, and 1.0 g/d for the weight below 49 kg, in two divided doses. Prednisone was ad- ministrated as per ruler of each center. ResultsObservation termination was 3 months. Morbility of actue rejection was 3.40% (2/58)and 13.6% (3/22) in experimental and control group(P>0.05). Ad-verse events including hypertension, hyperlipemia, hyperglycemia and slight abnormality of liver func-tion occurred in 36. 2%(21/58) and 36. 4% (8/22) cases of experimental and control group(P> 0. 05). The survival rate in the 2 groups was 100%. The dose of tacrolimus in experimental group was significantly lower than that in the control group at 8 and 12 weeks posttransplant, while drug valley concentration in serum was proximal in 2 groups during the whole observation period.Conclusion Domestic tacrolimus capsules can be used effectively and safely in the management of acute rejection in renal transplantation.

Objective To investigate the role of soluble CD305(sCD305)in renal allograft rejection.Methods Concentration of serum sCD305 was detected on 20 healthy volunteers and 153 cases of recipients after kidney transplantation by using double monoclonal antibody sandwich enzyme linked immunosorbent assay.Results In the healthy volunteers and 98 recipients with normal renal funetion,sCD305 was detected at low levels of(4.3±2.3)μg/L and(6.3±3.7)μg/L.In 20 cases of acute rejection and 5 cases of graft loss,serum sCD305 levels were(36.3±14.7)μg/L and(28.8±9.4)μg/L,and significantly higher than those in the healthy volunteers and recipients with normal renal function.Meanwhile,in the 30 cases of chronic rejection and 6 cases under dialysis treatment,the levels of sCD205were(13.1±5.5)ttg/L and(11.2±4.6)μg/L and significantly higher than those in the healthy volunteers and recipients with normal renal function.Conclusions CD305 was presented at high level in the recipients with renal acute or chronic rejection,and it might be a potential marker for monitoring graft rejection after transplantation.