Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation .Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018 .The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared .Results After desensitization treatment , 14 recipients successfully underwent ABOi-kidney transplantation . Within 2 weeks post-transplantation , blood group antibody rebounded to 1:64 in only 1 recipient .Within 1 week post-transplantation ,the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients .Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment . Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy . Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year .Thirteen cases (92 .6％ ) demonstrated varying degrees of peritubular capillary deposition of C 4d .One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment . During an early stage , the incidence of postoperative infection was 57 .14％ and declined to 14 .29％ after optimized desensitization .The expenditure of early desensitization treatment was (27004 .86 ± 10719 .85) yuan and (10612 .29 ± 8143 .05) yuan after optimization .And the expenditure of optimized desensitization was significantly lowered (P<0 .05) . During follow-ups ,renal allograft function of 14 recipients remained decent .And the survival rate of recipient/allograft was 100％ up to the statistical cut-off point .Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent .The expenditure of desensitization treatment is significantly lowered after optimization .

Objective To investigate the population pharmacokinetic characteristics of milnacipran in Chinese healthy volunteers and factors co-variables that might impact its clearance.Methods The clinical data and blood samples were collected from a pharmacokinetics (PK) study (n =24) which was designed as a randomized,three-way cross-over,single dose (25,50 or 100 mg) and in multiple doses for 8 d (up to 100 mg · d-1 administered as 50 mg twice daily) in Chinese healthy volunteers.Both the single and multiple-dose studies included 12 volunteers (six males and six females).The concentration of milnacipran in plasma was analyzed by HPLC-MS/MS.Non-linear mixed-effects model (NONMEM) was used to assess the influence of demographic characte-ristics on PK characters of milnacipran.The final model was diagnosed by goodness-of-fit plots and evaluated by bootstrap methods.Results A one-compartment model was developed to capture the milnacipran pharmacokinetics.Typical value of clearance (CL),the volume of distribution (V),and maximum absorption rate (Ka) were 37.53-44.16 (40.84 ± 1.69) L h-1,382.89-433.37 (408.13 ± 12.86) L and 0.81-1.31 (1.06 ± 0.13) /h,respectively,and age or sex had no influence on CL of milnacipran.No obvious bias was found by bootstrap method.Conclusions The developed model can capture milnacipran pharmacokinetics well in healthy volunteers.Age and genderhad no influenceon minacipran PK profiles in healthy subjects.

Objective To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on cal-caneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot.Methods From April 2018 to October 2021,a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot,includ-ing 2 males and 3 females,aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification.All patients were treated with debridement,vancomycin bone cement implantation,negative pressure aspiration at stage Ⅰ,vancomycin calcium sulfate and internal fixation at stage Ⅱ for calcaneal beak-like fracture.Surgical incision and fracture healing time were recorded,and the recurrence of osteomyelitis was observed.American Orthopedic Foot Andankle Society(AOFAS)score and exudation at 12 months after operation were evaluated.Results Five patients were successfully completed operation without lower extremity vascular occlusion,and were followed up for 16 to 36 months.The wound healing time after internal fixation ranged from 16 to 26 days,and healing time of fractures ranged from 16 to 27 weeks.AOFAS score ranged from 65 to 91 at 12 months after oper-ation,and 2 patients got excellent result,2 good and 1 fair.Among them,1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation(non-complication),was recovered after treatment;the wound leakage complication oc-curred in 2 patients,and were recovered after dressing change.No osteomyelitis or fracture occurred in all patients.Conclusion Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection,but also promote fracture healing,and obtain good clinical results.