Objective To compare the differences of the four estimating equations about MDRD,CKD-EPI eGFRcr,CKD-EPI eGFRcys,and eGFRcr-cysin evaluating the renal function of kidney transplant recipients,and explore the optimal equations to estimate the renal allograft function.Method Between January 2000 to March 2015,a total of 213 renal transplant recipients with data integrity were enrolled.eGFR was calculated using the equations:Modification of Diet in Renal Dis-ease [eGFR (MDRD),the creatinine-based equation (CKD-EPI eGFRcr),the CKD EPI cystatin C equation (CKD-EPI eGFRcys),and CKD EPI creatinine + cystatin C equation (CKD-EPI eGFRcr-cys) drafted by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) in 2009 and 2012.We assessed the performance of these four eGFR equations by Pearson correlation analysis,Bland-Altman plot,and Cox regression analysis.Result The incidence of reduced kidney function was 49.3％ using MDRD,43.7％ using eGFRcr,49.8％ using eGFRcys,and 52.1％ using eGFRcr-cys,respectively.In recipients with eGFR ≥60 ml·min· 1.73 m2 estimated by MDRD,19.5％ and 11％ had eGFR ＜60 ml·min·1.73 m2 re-estimated by eGFRcys and eGFRcr-cys respectively.Serum cystatin C was significantly correlated with serum creatinine,MDRD,eGFRcr,eGFRcr-cys with the correlation coefficient being 0.67,0.61,0.65,and 0.77 respectively.Only the CKD staging based on eGFRcr,and eGFRcr-cys was positively related to renal graft loss risk.eGFRcr,and eGFRcr-cys could not be replaced each other,and only eGFRcr-cys showed strong correlation with the other three equations.Conclusion As compared with others,eGFR (CKD-EPI-Creat + CysC) is more precise in estimating GFR and evaluating the renal graft loss risk.

Spontaneous splenic rupture in acute leukemiapatients was rarely seen and the prognosis was ex-tremely bad. In this article the authors discussedthe early diagnosis, mechanism and treatment ofsplenic rupture in acute leukemia patients on thebasic of 3 cases treaed in our hospital. The authorsrecognized that it was a useful diagnostic methodto chech up with "B" model utrasound wave andthat to conduct splenectomy was an effectivemethod of live-saving treatment.

OBJECTIVETo investigate the dynamic features of angiogenesis in residual tumors after high intensity focused ultrasound (HIFU),and to determine the temporal effect and mechanism of hypoxia inducible factor-2 alpha (HIF-2a) in the angiogenic process of residual tumors.

METHODSXenograft tumors of HepG2 cells were generated by subcutaneously inoculating athymic BALB/c nu/nu mice with the hepatoma cells.About 30 days after inoculation,all mice (except in the control group) were treated by HIFU and assigned randomly to the following 7 groups according to various time intervals post-treatment:1st,3rd,5th day and 1st,2nd,3rd,4th week when the residual tumor tissues were obtained from the experimental groups.Protein levels of HIF-2a and vascular growth factor A (VEGF-A) were quantified by immunohistochemistry and western blotting,and mRNA levels were measured by (real-time quantitative) qPCR. Microvascular density (MVD) was calculated by counting the CD31-positive vascular endothelial cells identified by means of an immunohistochemical staining method.

RESULTSCompared with results from the control group,the protein and mRNA levels of HIF-2a expression reached the highest level in the experimental mice at the 2nd week (P=0.000 and P < 0.01 respectively),and were decreased thereafter(3rd week and 4th week, P=0.000 and P < 0.05).VEGF-A expression in the residual tumor tissues group that received HIFU was significantly decreased,compared with the control group,at all time points uPto 1 week (all P=0.000 and P < 0.01),but the levels increased compared to controls in the 2nd through 4th week (all P=0.000, P < 0.05). Similar results were obtained for MVD.

CONCLUSIONHIFU treatment can inhibit angiogenesis in residual hepatoma tissues in the short-term (1 to 2 weeks post-treatment) in mice with hepatocellular carcinoma,but can promote angiogenesis overtime (2 to 4 weeks post-treatment); the angiogenic process may involve the HIF-2α/VEGFA pathway.

Animals ; Blotting, Western ; Carcinoma, Hepatocellular ; pathology ; Hep G2 Cells ; High-Intensity Focused Ultrasound Ablation ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Immunohistochemistry ; Liver Neoplasms ; pathology ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasm Transplantation ; Neovascularization, Pathologic ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo observe the expression of CD(14) protein and CD(14) gene in liver sinusoidal endothelial cells (LSECs) of rats during endotoxemia and the role of CD(14) protein in the activation of lipopolysaccharide (LPS)-induced LSECs.

METHODSWistar rat endotoxemia model was established by injection of a dose of LPS (5 mg/kg, Escherichia coli O111:B4) via the tail vein of the rats, then sacrificed immediately, at 3, 6, 12, and 24 h, respectively. LSECs were isolated from normal and LPS-injected rats by the in situ collagenase perfusion technique. The isolated LSECs were incubated with anti CD(14) polyclonal antibody, then followed by staining with goat anti-rabbit IgG conjugated fluorescein isothiocyanate (FITC). The percentage and mean fluorescence intensity (MFI) of CD(14)-positive cells were detected by the flow cytometric analysis (FCM). LSECs were collected to measure the expression of CD(14) mRNA by the in situ hybridization analysis. The isolated LSECs from normal rats were divided into two groups. Group of LPS: LSECs were induced with different concentration of LPS (0, 0.01 microg/ml, 1 microg/ml, 10 microg/ml, and 100 microg/ml). Group of anti-CD(14) blockade: LSECs were pre-incubated for 30 min with CD(14) antibody before different concentrations of LPS were added. The supernatants of these cells were then collected for measuring the levels of tumor necrosis factor (TNF)- alpha and interleukin (IL)-6.

RESULTSIn rats with endotoxemia, LSECs displayed a strong MFI distinct from that of control rats. The number of FITC-CD(14) positive LSECs was 54.32%, 65.83%, 85.61%, and 45.65% at 3, 6, 12, and 24 h, respectively, which increased markedly when compared to control rats (4.45%, P<0.01). The expression of CD(14) mRNA in LSECs was stronger than that in control rats. The levels of TNF-alpha were significantly increased in group of LPS (54.49 +/- 6.02 pg/ml, 84.65 +/- 10.16 pg/ml, 206.54 +/- 23.55 pg/ml, 349.87 +/- 39.47 pg/ml, and 365.76 +/- 40.31 pg/ml) than those in group of anti-CD(14) blockade (55.93 +/- 6.95 pg/ml, 63.32 +/- 7.81 pg/ml, 85.34 +/- 9.72 pg/ml, 112.75 +/- 13.54 pg/ml, and 198.66 +/- 21.54 pg/ml) (P<0.01). The levels of IL-6 also increased significantly in group of LPS (103.34 +/- 12.52 pg/ml, 187.39 +/- 20.31 pg/ml, 243.87 +/- 27.83 pg/ml, 289.51 +/- 30.15 pg/ml, and 298.53 +/- 31.94 pg/ml) than those in group of anti-CD(14) blockade (104.37 +/- 11.49 pg/ml, 125.02 +/- 13.58 pg/ml, 164.59 +/- 19.47 pg/ml, 183.47 +/- 20.17 pg/ml, and 221.76 +/- 26.43pg/ml) (P<0.01).

CONCLUSIONSLSEC can synthesize CD(14) protein and express CD(14) gene during endotoxemia. Anti CD(14) antibody can inhibit the production of TNF-alpha and IL-6 in LSECs induced by LPS. The expression of CD(14) protein may take an important part in the activation of LSECs induced by LPS.

Animals ; Dose-Response Relationship, Drug ; Endothelium, Vascular ; drug effects ; metabolism ; pathology ; Endotoxemia ; metabolism ; pathology ; Escherichia coli Infections ; metabolism ; pathology ; Gene Expression Regulation ; drug effects ; Interleukin-6 ; metabolism ; Lipopolysaccharide Receptors ; biosynthesis ; genetics ; Lipopolysaccharides ; administration & dosage ; Liver ; drug effects ; metabolism ; pathology ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Wistar ; Tumor Necrosis Factor-alpha ; metabolism

Objective To compare the difference of all-cause mortality between diabetic and non-diabetic transplant recipients.Methods This population cohort study included all primary kidneyonly transplant recipients with data integrity between Jan.2000 and May 2017,the deadline date of follow-up was May 2018,and median follow-up period was 5.9 (range 1.1 to 17.1) years.According to whether the recipients had diabetes,they were divided into type 2 diabetes group (DM group),and no diabetes group (non-DM group).The clinical data of the two groups including recipients and donors were collected.The all-cause mortality and difference in dead causes were analyzed.Results Mortality was higher in DM group than in non-DM group.Compared with non-DM group,the relative risk(RR) for all-cause mortality in DM group was 2.25 (95％ CI:1.23-4.12).The cumulative survival rate in non-DM group was significantly higher than that in DM group(Log Rank P =0.035).The DM group aged younger than 40 years had the highest risk (RR 4.50),but there was no significant difference between the two groups at the age of ≥40 years.Compared with living donor and cadaveric donor renal transplantation,the relative mortality risk in DM group in DCD donor renal transplantation was highest (RR 2.68).The transplantation time did not change the multiple risk of death in both groups (adjusted RR 2.13).The first cause of death in two groups was infection (50％ in DM group vs.53.3％ in non-DM group).The difference was not statistically significant.Conclusion Kidney transplant recipients with type 2 diabetes had higher all-cause mortality than in those without diabetes.Compared with non-diabetic recipients,the age ＜40 years and receiving DCD for kidneys had a greater impact on the all-cause mortality of diabetic recipients.Infection was the leading cause of death in both groups.

Objective: To establish the mouse aorta dissection (AD) model through drinking water containing β-aminopropionitrile (BAPN). Methods: Forty 3-week-old C57B1/6J male mice were divided into four groups according to randomized block design: control, 0.2, 0.4 and 0.8 g·kg^-1·d^-1 BAPN groups (dissolving respective dose of BAPN in the drinking water, n=10 each group). Arterial systolic blood pressure and heart rate were measured weekly in conscious, restrained mice using a noninvasive computerized tail-cuff system. Mice those died of rupture of aortic dissecting aneurysm during the study were autopsied and the aorta was examined. After 4 weeks, survived mice were sacrificed by an overdose of sodium pentobarbital and the whole aorta was harvested and analyzed. Results: The incidence of AD and the mortality of ruptured AD was 0 and 0 in control group, 30% (3/10) and 20% (2/10) in 0.2 g·kg^-1·d^-1 BAPN group, 50% (5/10) and 40% (4/10) in 0.4 g·kg^-1·d^-1 BAPN group, 90% (9/10) and 70% (7/10) in 0.8 g·kg^-1·d^-1 BAPN group (both P<0.05 vs. control group). The incidence of AD and the mortality of ruptured AD increased in proportion to BAPN concentration increase. In 0.8 g·kg^-1·d^-1 BAPN group, 7 mice died of dissecting aneurysm rupture during the experiment, among which 5 dissecting aneurysms were mainly located in the thoracic aorta and 2 dissecting aneurysms in abdominal aorta. The diameters of thoracic aorta and abdominal aorta were (1.38±0.19) and (1.23±0.13) mm in control group, (2.43±1.56) and (1.30±0.26) mm in 0.2 g·kg^-1·d^-1 BAPN group, (2.45±1.28) and (1.30±0.31) mm in 0.4 g·kg^-1·d^-1 BAPN group, (2.87±0.57) and (1.95±0.81) mm in 0.8 g·kg^-1·d^-1 BAPN group (both P<0.05 vs. control group). The diameters of thoracic aorta and abdominal aorta in mice also increased in proportion with BAPN concentration increase. Furthermore, blood-filled false lumen formation and elastic fibers fragmentation were evidenced in hematoxylin-eosin stained and Vitoria blue-Sirius red stained aortic cross-sections of mice in the 0.8 g·kg^-1·d^-1 BAPN group. Conclusion BAPN treatment induced aortic dissection model in C57Bl/6J mice can serve as a useful wild-type mouse model for the mechanism and pharmaceutical studies of AD.

Objective:To explore the influencing factors of continuous renal replacement therapy(CRRT)after heart transplantation(HT).Methods:For this retrospective cohort study, the relevant clinical data were retrospectively reviewed for 145 recipients undergoing HT at No.7 Municipal People's Hospital from April 2018 to December 2022.They were assigned into two groups of non-CRRT(n=124)and CRRT(n=21). And t, χ2or rank-sum test was utilized for comparing baseline data, intraoperative and postoperative general conditions of two groups.Variables with P<0.05 in univariate analysis and significant indicators in previous studies were included in multivariate logistic regression analysis to analyze the influencing factors of CRRT post-HT.Receiver operating characteristic curve(ROC)was utilized for selecting the optimal predictive cut-off value. Results:Among them, 66 cases(45.52%)developed AKI and 21(14.48%)required CRRT.Through univariate analysis, preoperative estimated glomerular filtration rate(eGFR), erythrocyte count, platelet, hemoglobin, total bilirubin, intraoperative volume of blood loss, volume of blood transfusion, urine volume, operative duration, cardiopulmonary bypass time, postoperative mechanical ventilation time, ICU stay and postoperative acute kidney injury were compared.The inter-group differences were statistically significant( P<0.05). Further multivariate logistic regression analysis revealed that preoperative hemoglobin level( OR=0.869, 95% CI: 0.770-0.980, P=0.022), preoperative platelet count( OR=0.959, 95% CI: 0.925-0.993, P=0.019), intraoperative volume of hemorrhage( OR=1.004, 95% CI: 1.000-1.009, P=0.049), intraoperative urine volume( OR=0.997, 95% CI: 0.993-1.000, P=0.035), operative duration( OR=1.022, 95% CI: 1.000-1.044, P=0.047)and mechanical ventilation time( OR=1.036, 95% CI: 1.005-1.069, P=0.024)were the independent influencing factors of CRRT post-HT.ROC curve results indicated that area under curve(AUC)of operative duration, mechanical ventilation time and intraoperative volume of hemorrhage were 0.745(95% CI: 0.636-0.855), 0.835(95% CI: 0.735-0.934)and 0.669(95% CI: 0.506-0.830)with a sensitivity of 0.714, 0.857, 0.571 and a specificity of 0.710, 0.685, 0.895.And the cut-off values were 283.5 min, 25.46 h and 825 ml respectively. Conclusions:Hemoglobin level, preoperative platelet count, intraoperative volume of hemorrhage, urine volume, operative duration, mechanical ventilation time and intraoperative urine volume are independent influencing factors of CRRT post-HT.Operative duration >283 min, mechanical ventilation time >25.46 h and intraoperative volume of hemorrhage >825 ml have some predictive values for CRRT post-HT.

OBJECTIVESTo observe the synthesis of Toll-like receptor (TLR) 4 protein and its mRNA expression in Kupffer cells (KCs) and evaluate the role of TLR 4 in liver injury to rats through alcohol-induced liver disease.

METHODSTwenty-eight Wistar rats were divided into two groups: ethanol-fed (group E) and control (group C). Group E rats were given ethanol at a dose of 5 - 12 g x kg(-1) x d(-1), while group C received dextrose. Animals from both groups were killed at 4 and 8 weeks. The KCs were isolated and synthesis of TLR 4 protein was determined by laser scanning confocal microscopy. TLR 4 mRNA expression in KCs was determined by reverse transcription polymerase chain reaction (RT-PCR) analysis. The levels of endotoxin, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in plasma were determined. Changes in liver pathology were observed.

RESULTSLaser scanning confocal microscopy showed that the intensity of fluorescence of TLR 4 protein in group E was stronger than group C. Ethanol administration led to a significant increase in TLR 4 mRNA expression in group E compared with group C (P < 0.05). The concentrations of plasma endotoxin, TNF-alpha and IL-6 were higher in group E than in group C (P < 0.05). Liver sections from rats in group E demonstrated marked pathological changes.

CONCLUSIONEthanol administration can lead to the synthesis of TLR 4 protein and its gene expression in KCs, indicating that TLR 4 may play a major role in the development of alcohol-induced liver injury.

Animals ; Drosophila Proteins ; Female ; Interleukin-6 ; blood ; Kupffer Cells ; physiology ; Lipopolysaccharide Receptors ; physiology ; Liver Diseases, Alcoholic ; etiology ; pathology ; Membrane Glycoproteins ; genetics ; physiology ; RNA, Messenger ; analysis ; Rats ; Rats, Wistar ; Receptors, Cell Surface ; genetics ; physiology ; Toll-Like Receptor 4 ; Toll-Like Receptors ; Tumor Necrosis Factor-alpha ; analysis

Objective:To investigate the predictive value of postoperative C-reactive protein for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 298 patients with advanced gastric cancer who underwent Da Vinci robotic surgical system radical gastrectomy in the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2017 to June 2019 were collected. There were 253 males and 45 females, aged from 24 to 86 years, with a median age of 60 years. Of the 298 patients, 275 cases underwent no serious postoperative complications and 23 cases underwent serious postoperative complications. Observation indicators: (1) serious postoperative complications; (2) analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer; (3) performance evaluation of the predictive indicators. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using Logistic regression model. The receiver operating characteristic curve was drawn and the area under curve (AUC) was used to compare and estimate the efficiency of diagnostic criteria. The value of Youden index was used to determine the optimal cut-off point. Results:(1) Serious postoperative complications: of the 298 patients, 23 cases underwent complications classified ≥grade Ⅲa of Clavien-Dindo classifica-tion, including 10 cases with grade Ⅲa complications, 7 cases with grade Ⅲb complications, 4 cases with grade Ⅳa complications, 1 case with grade Ⅳb complications and 1 case with grade Ⅴ complications. (2) Analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer. Results of univariate analysis showed that operation time, indicators of C-reactive protein concentration and neutrophil count at post-operative day 1, and indicators of C-reactive protein concentration, white blood cells count, neutrophil count and platelet count at postoperative day 3 and pathological stage were related factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( χ2=7.671, 4.504, 5.045, 48.293, 9.575, 15.436, 13.731, 9.537, P<0.05). Results of multivariate analysis showed that the operation time ≥250 minutes, the concentration of C-reactive protein at postoperative day 3 ≥16.65 mg/dL, the neutrophil count at postoperative day 3 ≥8.167×10 9/L, the platelet count at postoperative day 3 ≥218×10 9/L and the pathological stage of tumor as stage Ⅱ and stage Ⅲ were independent risk factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( odds ratio=3.721, 16.084, 6.056, 6.893, 12.455, 95% confidence interval: 1.032-13.421, 4.657-55.547, 1.073-34.163, 1.798-26.423, 1.338-115.930, P<0.05). (3) Performance evaluation of the predictive indicators: the C-reactive protein concentration at postoperative day 3 was a high-performance predictor with the AUC as 0.851 (95% c onfidence interval: 0.780-0.921, P<0.05) and neutrophil count and platelet count at postoperative day 3 were low-performance predictors with the AUC as 0.659 and 0.666 (95% confidence interval: 0.570-0.748 and 0.581-0.750, P<0.05). Conclusion:The C-reactive protein concentration ≥16.65 mg/dL at postoperative day 3 is a high performance predictive indicator for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.

Objective:To evaluate Castor single-branch covered-stent in the treatment of Stanford B aortic dissection(TBAD)with insufficient anchorage zone.Methods:Clinical data of 25 TBAD patients (proximal healthy landing zone ≤15 mm) treated with Castor branched stent-graft at Weifang People's Hospital from Apr 2019 to Sep 2021 were analyzed retrospectively.The stent model was selected according to preoperative CTA examination and intraoperative angiography,the operation result and follow up data were reviewed.Results:The operation success rate was 100%,the mean operative time was (137.8±35.8)min, and the mean blood loss was (52.8±24.5)ml. There were 2 cases of internal leakage (IA) and it was disappeared after balloon dilation, Branched stent stenosis occurred in 2 cases and relieved by balloon dilatation. The mean follow-up time was 14.6 months, and the patency rate of branch stent was 100% during the follow-up period. The true lumen diameter of thoracic aorta was significantly expanded and the false lumen diameter was significantly reduced 3 months after surgery compared with that before surgery ( P<0.05). Conclusion:Castor stenting in the treatment of TBAD with insufficient proximal anchoring area is simple and feasible, with satisfactory short term clinical effect.