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 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 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 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 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 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.

Objective To assess the impact of a single hemodialysis on the left ventricular systolic function of uremia patients with 3-dimensional ultrasound speckle tracking imaging (3D-STI).Methods Thirty-seven clinically stable outpatients with uremia undergoing hemodialysis were studied.The echocardiographic examinations were obtained in 30 minutes before and after homodialysis.Twenty nine normal subjects with age and sex matched were selected as control groups.Conventional ultrasound was recorded and then left ventricular mass index(LVMI) was calculated.The peak systolic mitral annular velocity S' was recorded by tissue Doppler imaging.3D-STI imaging were recorded from standard left ventricular apical 4-chamber views before and after a single hemodialysis.Left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),left ventricular ejection fraction (LVEF),and left ventricular global longitudinal peak systolic strain (LVGLS),left ventricular global radial peak systolic strain (LVGRS),left ventricular global circumferential peak systolic strain (LVGCS),left ventricular global area peak systolic strain (LVGAS) were measured.The indicators of conventional ultrasound and 3D-STI were compared between the pre-hemodialysis group and the normal control group,and also between pre-and post-hemodialysis groups.Results ①Compared with the control group,the left ventricular end-diastolic diameter (LVDD),interventrieular septal thickness at diastole (IVSD),left ventricular posterior wall thickness at diastole(LVWPD),left atrial diameter(LAD) in the group before a single hemodialysis were significantly higher (P ＜0.05 for all).Meanwhile,the S' was significantly lower (P ＞0.05) and LVMI was significantly higher in the pre-hemodialysis group than the control group(P ＜ 0.05).The LVDD,LAD,left atrial volume index(LAVI) were significantly lower in the post-hemodialysis group than that in the pre-hemodialysis group(P ＜0.05 for all).②Results of 3D-STI showed that the LVEF,LVGLS,LVGCS,LVGRS,LVGAS was significantly lower,however LVEDV,LVESV were higher in the pre-hemodialysis group compared with the control group (P ＜ 0.05 for all).After a single hemodialysis,LVEDV,LVESV,LVGLS were significantly lower than before(P ＜0.05 for all),but LVEF,LVGRS,LVGCS,LVGAS were not significantly changed (P ＞ 0.05 for all).Conclusions After a single hemodialysis,the whole systolic function of the left ventricular was not changed.but the left ventricular global longitudinal peak systolic strain was significantly lower.The parameter of LVGLS was sensitive to the change of preload and was volume-load dependent.The preload of the patients should be sufficiently considered when the LVGLS are measured in the patients with uremia undergoing hemodialysis.

Objective To summarize the clinical experience of antibody induction therapy in renal re-transplantations and compare the outcomes among different antibodies.Methods We retrospectively investigated 39 recipients after renal re-transplantations in our center.According to the induction agents,patients were divided into three groups as follows:basiliximab (Bax) group (patients treated with Bax,n =12),T lymphocyte polyclonal antibody (ALG) group (patients treated with ALG,n =19) and thymoglobuline (ATG) group (patients treated with ATG,n =8).Incidence of acute rejection,graft loss and cytomegalovirus infection was analyzed,as well as graft survival rate and serum creatinine one year after transplantation.Results Acute rejection occurred in 5 patients of Bax group (5/12,41.7 ％),in 9 patients of ALG group (9/19,47.4 ％) and 1 patient of ATG group (1/8,12.5 ％).The acute rejection rate was similar in Bax and ALG groups,but significantly decreased in ATG group.The 1-year survival rate of re-transplant recipients was 84.6 ％.There were no significant differences in 1-year survival rote between Bax group and ALG group (82.4 ％ vs 80.5 ％),while ATG group showed higher survival rate (90.8 ％).The renal function in ATG group was improved at 1st year after re-transplantation:serum creatinine (121.3 ± 22.6) μmol/L vs (176.8±43.5)μmol/L in Bax group and (195.4 ± 35.2) μmol/L in ALG group respectively.There were 2patients with CMV infection in Bax group,3 patients in ALG group and 2 patients in ATG group.There was no significant increase in infection incidence between ATG group and Bax or ALG groups during the follow-up period.Conclusion Retrospective analysis from monocenter and small samples indicated that ATG induction treatment seems to be effective in decreasing acute rejection risk andachieving better outcomes in the renal re-transplant recipients without increased CMV infection incidence.