Kidney transplantation has become the optimal treatment for end-stage renal disease. However, the demand for kidney exceeds the available supply. In last years, living-related kidney transplantation has progressively increased because of the less rejection, the higher achievement ratio and so on. From 2007 to 2008 ,our hospital succeed in 196 living-related kidney transplantation based on the previous work.

Objective To investigate the clinical efficacy of warming and unblocking acupuncture in treating scapulocostal syndrome.Method Eighty patients with scapulocostal syndrome meeting the inclusion criteria were allocated by simple randomization to warming and unblocking acupuncture and conventional acupuncturegroups, 40 cases each.The warming and unblocking acupuncture group received warming and unblocking acupuncture at points Tianzong(SI11), Jianjing(GB21)and Dazhui(GV14)on the affected side and affected chest Huatuo jiaji(Ex-B2)points and uniform reinforcing-reducing acupuncture at points Quchi(LI11), Hegu(LI4)and Waiguan(TE5).The conventional acupuncture group received uniform reinforcing-reducing acupuncture at the same points as those in the warming and unblocking acupuncture group after arrival of qi.Both groupswere treated once every other day, 10 days as a course, for a total of one course.Pain severity was assessed using the Pain Visual Analogue Scale(VAS) in the two groups of patients before and after treatment.Theclinical therapeutic effects were evaluated by follow-up at one month after the completion of treatment.Result The total efficacy rate was 95.0% (38/40) in the warming andunblocking acupuncture group and 80.0% (32/40) in the conventional acupuncture group; there was a statistically significant difference (P<0.05).The PainVisual Analogue Scale(VAS) score was significantly lower in the two groups of patients after treatment than before treatment; there was a statistically significant difference (P<0.05).The VAS score was decreased more in the warming and unblocking acupuncture group after treatment and at the follow-up one month after the completion of treatment (P<0.05).Conclusion Warming and unblocking acupuncture has clinically a better therapeutic effect onscapulocostal syndrome.

Objective To study the HLA match rate of 222 living-related donors for kidney transplantation, and to give suggestions for clinical selection of suitable donors and recipients. Methods We analyzed the HLA match rate of 222 kidney transplantations from living relative donors from April 2006 to December 2008. There were 168 male recipients and 54 female recipients. The ages of 222 recipients ranged from 10 to 58. There were 133 male donors and 89 female donors. The ages of 222 recipients ranged from 21 to 64.Results The HLA-A, B, DR, DR, antigens of 87 kidney transplantations from living parental donors were half-matched, of which 14 were higher than half-matched. The HLA-A, B, DR, DQ antigens of 7 kidney transplantations from living children donors were half-matched, including 2 cases higher than half-matched.Among 56 kidney transplantations from living sibling donors, 12 cases were totally mated, 34 cases were half-matched, and the rest were less than half-matched or mismatched. Among 72 kidney transplantations from other living relative donors, 20 cases were higher than half-matched and 5 cases were completely mismatched. More than 4 HLA antigens in 6 cases were matched, but not half-matched. Three HLA antigens or less were matched in 41 cases. Conclusion The HLA match rates from living parental, children, or sibling donors were higher than other relative donors.

Objective To observe the effects of buccal acupuncture therapy and body acupuncture therapy on plasma metabolomites of rheumatoid arthritis rabbits model; To search for the metabolites related to the mechanism of buccal acupuncture and body acupuncture. Methods Sixteen rabbits were made into rheumatoid arthritis models by complete freund's adjuvant before the treatment. The buccal acupuncture group was treated by buccal acupuncture on the knee acupoint; 13 mm × 0.32 mm needle straight 0.2–0.5 mm, twist the main points of stimulation 15 s, once a day. The body acupuncture group was treated by body acupuncture on the Xiyan and Zusanli acupoints; with 13 mm × 0.32 mm needle straight 2–3 mm, every 5 min each time, twisting needle method, 100 times/min for 15 s, once a day. After the continuous treatment for 5 days, UPLC-QTOF/MS was applied to test metabolite from the plasma sample of all groups. Similarity analysis, hierarchical cluster analysis (HCA), principal component analysis (PCA), orthogonal partial least squares-discriminant analysis (OPLS-DA) were applied in this research; meanwhile load analysis method was used to identify the meaningful metabolites. Results The similarity analysis, HCA and PCA all showed the significant difference of endogenous metabolites in plasma samples among the buccal acupuncture group, the body acupuncture, the model group and the blank group. The 4 groups of different plasma sample metabolite were completely separated in three dimensions by OPLS-DA and all the samples were gathered respectively. The load analysis indicated that there were 19 kinds of endogenous metabolites which showed the significant differences between buccal acupuncture group and model group, and also happened between the body acupuncture group and the model group; N-cetyl-L-phenylalanine and 2-phenyl propionate in metabolism of phenylalanine and tyrosine decreased significantly in the buccal acupuncture group while significantly increased in the body acupuncture group. Conclusion There are relative similarity on the mechanism of treating rheumatoid arthritis between buccal acupuncture and body acupuncture. However, N-acetyl-L-phenylalanine and 2-phenyl propionate, as the main potential biomarkers of the difference, indicate that the dissimilarity can be significant.

Objective:To observe the analgesic effect of acupuncture and to explore its central analgesic mechanism in rheumatoid arthritis rabbits.Methods:A total of 60 flap-eared white rabbits were randomly assigned into a normal control group (n=6),a model group (n=6),a body-acupuncture group (n=24),and a buccal acupuncture group (n=24).The later 2 groups were further randomly assigned into 0,0.5,1,and 2 h subgroups,with 6 cases in each group.The rheumatoid arthritis model was established by induction of eggalbumin.In the body acupuncture group,bilateral Xiyan and Zusanli were punctured for 15 s while in the buccal acupuncture group,acupuncture was applied to Xi for 15 s,with the needle retaining for 30 min.The pain threshold was detected with PL-200,taking struggle movements of rabbits as a measurement index,response latency from irradiation to struggling movements as the rabbit's pain threshold.The contents of β-endorplhin (β-EP) and cholecystokinin-8 (CCK-8) in cerebrospinal fluid were examined by radioimmunoassay.Results:Compared with the control group,pain threshold and CCK-8 levels decreased significantly (P＜0.01) and the concentration of β-EP significantly increased (P＜0.05) in the model group.The pain threshold in the body-acupuncture group and the buccal acupuncture group at 0 and 1 h (P＜0.05 or P＜0.01) increased significantly,while the β-EP and CCK-8 contents in the bodyacupuncture group and the buccal acupuncture group were significantly higher than those in the model group (P＜0.01 or P＜0.05).Both β-EP and CCK-8 contents in the buccal acupuncture group at 0 h were significantly higher than those in the body-acupuncture group (P＜0.05).Conclusion:The analgesic effect of buccal acupuncture is superior to that of body-acupuncture.Both buccal acupuncture and body-acupuncture can effectively raise the pain threshold in acute arthritis rabbits,which is closely associated with their effects in the up-regulation of β-EP and CCK-8 contents in cerebrospinal fluid.

This study compared the efficacy and safety of tiotropium bromide inhalation powder (spiriva) and doxofylline oral tablet (doxofylline) in the treatment of chronic obstructive pulmonary disease (COPD). A multi-center, randomized, double-blind, double-dummy, parallel-controlled study involved 127 eligible stable moderate to severe COPD patients treated with inhaled tiotropium dry powder (18 μg/day) or oral doxofylline tablets (0.2 g/time, 2 times a day) for 12 and 24 weeks. Before and after treatment for 12 weeks and 24 weeks, respectively, pulmonary function, 6-min walking distance and dyspnea index were recorded. The results showed that in both tiotropium group and doxofylline groups, after 12-week treatment, FEV(1), FEV(1)/FVC% and 6-min walk distance were significantly higher than those before the medication, while dyspnea index decreased as compared with that before treatment. After 24-week treatment, a slight improvement in the measures was observed as compared with that of 12-weeks treatment, but the difference was not statistically significant. With both 12-week and 24-week treatment, the effect of tiotropium was slightly better than that of doxofylline tablets, with the difference being statistically insignificant. The major adverse events in the tiotropium group and doxofylline group were observed in 9 cases (9.9%) and 12 cases (12.9%), respectively, and no statistically significant difference was found between them. We are led to conclude that both tiotropium at 18 μg a day and doxofylline tablets at 0.2 g/day (two times a day) are effective and safe for the treatment of COPD.

Objective To observe the effects of electroacupuncture on intestinal flora and serum inflammatory factors in rabbit model with rheumatoid arthritis(RA);To explore the mechanism of its therapeutic effect on RA.Methods RA model rabbits were established by ovalbumin induction combined with Freund's complete adjuvant,and the rabbits after successful modeling were randomly divided into model group,probiotic group and electroacupuncture group,with 6 rabbits in each group.Another 6 rabbits were set as the normal group.The electroacupuncture group received electroacupuncture at the bilateral"Zusanli"and"Dubi"for 30 minutes,the probiotic group was given probiotic capsules solution(14.5 mg/kg)by gavage,once a day,for two consecutive weeks.The knee joint circumference and pain threshold of rabbits were measured,histopathological morphological changes of colonic tissue and synovial tissue ws observed by HE staining,16S rDNA sequencing was used to analyze structural changes of intestinal flora,the contents of TNF-α,IL-1β and IL-6 in serum were detected by ELISA.Results Compared with the normal group,the circumference of knee joint of rabbits in the model group increased significantly,the pain threshold was significantly decreased(P<0.01);the colonic mucosal damage was serious,the goblet cells were missing,a large number of inflammatory cells were infiltrate;the joint capsule synovial surface was rough,the synovial cell layer was hyperplasia and thickening,the synovial tissue inflammatory cell infiltration was obvious;the number and evenness of gut microbiota species decreased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes decreased(P<0.05,P<0.01),the relative abundance of Desulfobacteria increased(P<0.01),while the relative abundance of Campylobacter,Lawsonella,and Pseudomonas increased(P<0.01),while the relative abundance of Heshanomonas and Herbaspirillum decreased(P<0.01);the contents of serum TNF-α,IL-1β and IL-6 increased(P<0.01).Compared with the model group,the knee joint circumference of the probiotic group and the electroacupuncture group decreased,the pain threshold increased(P<0.01,P<0.05);the degree of intestinal mucosal damage was reduced,the goblet cells were basically arranged neatly,the inflammatory cell infiltration was reduced;synovial cells proliferation and thickening decreased,with a small amount of inflammatory cell infiltration;the number and evenness of gut microbiota species increased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes increased(P<0.05,P<0.01),the relative abundance of Desulfobacteria decreased(P<0.01),while the relative abundance of Campylobacter,Lawsonella and Pseudomonas decreased(P<0.01),the relative abundance of Heshanomonas and Herbaspirillum increased(P<0.05,P<0.01);the contents of serum TNF-α,IL-1β and IL-6 significantly decreased(P<0.01).Conclusion Electroacupuncture can significantly improve the symptoms of RA rabbits and reduce the inflammatory reaction in synovial tissue of joint,and the mechanism may be related to the regulation of intestinal flora structure.

This study compared the efficacy and safety of tiotropium bromide inhalation powder (spiriva) and doxofylline oral tablet (doxofylline) in the treatment of chronic obstructive pulmonary disease (COPD).A multi-center,randomized,double-blind,double-dummy,parallel-controlled study involved 127 eligible stable moderate to severe COPD patients treated with inhaled tiotropium dry powder (18 μg/day) or oral doxofylline tablets (0.2 g/time,2 times a day) for 12 and 24 weeks.Before and after treatment for 12 weeks and 24 weeks,respectively,pulmonary function,6-min walking distance and dyspnea index were recorded.The results showed that in both tiotropium group and doxofylline groups,after 12-week treatment,FEV1,FEV1/FVC％ and 6-min walk distance were significantly higher than those before the medication,while dyspnea index decreased as compared with that before treatment.After 24-week treatment,a slight improvement in the measures was observed as compared with that of 12-weeks treatment,but the difference was not statistically significant.With both 12-week and 24-week treatment,the effect of tiotropium was slightly better than that of doxofylline tablets,with the difference being statistically insignificant.The major adverse events in the tiotropium group and doxofylline group were observed in 9 cases (9.9％) and 12 cases (12.9％),respectively,and no statistically significant difference was found between them.We are led to conclude that both tiotropium at 18 μg a day and doxofylline tablets at 0.2 g/day (two times a day) are effective and safe for the treatment of COPD.

Objective:To investigate the prognosis of robotic pancreatoduodenectomy after the learning curve and open pancreatoduodenectomy for pancreatic cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 396 patients who underwent curative pancreatoduodenectomy for pancreatic duct adenocar-cinoma in Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 were collected. There were 244 males and 152 females, aged 64(range, 36?92)years. Of 396 patients, 86 cases undergoing robotic pancreatoduodenectomy were divided into robotic group, 310 cases undergoing open pancreatoduodenectomy were divided into open group. Observa-tion indicators: (1) propensity score matching and comparison of general data between the two groups after matching; (2) follow-up and survival analysis. Follow-up was conducted by telephone interview or outpatient examinations including tumor markers and abdominal imaging examina-tions to detect survival of patients up to March 2022. Overall survival was defined as the time from the surgery date to death or the last follow-up. Disease-free survival was defined as the time from the surgery date to tumor recurrence or the last follow-up. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Normality of measurement data was examined using the Shapiro-Wilk test. Measurement data with skewed distribution were described as M(range), and comparison between groups was analyzed using the Mann-Whitney rank-sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used for survival analysis. An intent-to-treat analysis was performed in this study, patients who were converted to laparotomy from robotic surgery were still divided into the robotic group. Results:(1) Propensity score matching and comparison of general data between the two groups after matching: 164 of 396 patients had successful matching, including 82 cases in robotic group and open group, respectively. Before propensity score matching, the body mass index, cases in stage T1, T2, T3, T4, cases in N0, N1, N2 were 23.4(range, 21.4?25.3)kg/m 2,24, 41, 10, 11, 52, 27, 7 for the robotic group, versus 22.4(range,20.3?23.9)kg/m 2,57, 144, 22, 87, 131, 132, 47 for the open group, showing significant differences in the above indicators between the two groups ( Z=3.01, 2.63, 3.03, P<0.05). After propensity score matching, cases of males, age, body mass index, cases with American Society of Anesthesiologists (ASA) score as 1, 2, 3, CA19-9, cases with preoperative biliary drainage, cases with portal vein resection, cases with pancreatic resection margin <1 mm, cases in stage T1, T2, T3, T4, cases in stage N0, N1, N2, cases with nerve invasion, cases with tumor differentiation as high-medium differentiation, medium-low differentiation, low differentiation, cases with adjuvant chemotherapy were 51, 65(range, 59?69)years, 23.0(range, 21.0?25.2)kg/m 2, 32, 41, 9, 160.4(range, 46.7?377.2)U/mL, 21, 9, 8, 21, 40, 10, 11, 48, 27, 7, 76, 26, 47, 9, 53 for the robotic group, versus 58, 65(range, 58?69)years, 23.3(range, 21.4?25.3)kg/m 2, 35, 39, 8, 172.0(range, 69.7?402.9)U/mL, 26, 9, 10, 24, 40, 7, 11, 49, 28, 5, 76, 22, 49, 11, 57 for the open group, showing no significant difference in the above indicators between the two groups ( χ2=1.34, Z=0.18, 0.34, 0.49, 0.51, χ2=0.75, 0.00,0.25, Z=0.59, 0.27, χ2=0.00, Z=0.76, χ2=0.44, P>0.05). (2) Follow-up and survival analysis: after propensity score matching, 164 patients were followed up for 54(range, 1?67)months. The follow-up time of patients was 55(range, 51?59)months for the robotic group, versus 54(range, 50?58)months for the open group, respectively, showing no significant difference between the two groups ( Z=0.48, P>0.05). During the follow-up, the 1-year overall survival rate, 3-year overall survival rate, the median survival time, 1-year disease-free survival rate, 3-year disease-free survival rate, the median disease-free survival time, tumor recurrence rate, cases with recurrence pattern as local recurrence, liver recurrence, other distant recurrence, local and distant recurrence were 81.7%, 39.0%, 27 months(95% confidence interval as 19?33 months), 61.0%, 34.2%, 15 months(95% confidence interval as 12?18 months), 54.9%(45/82), 12, 16, 9, 8 for the robotic group. The above indicators were 79.3%, 36.0%, 24 months(95% confidence interval as 19?31 months), 59.8%, 27.5%, 15 months(95% confidence interval as 10?20 months), 58.5% (48/82), 10, 22, 6, 10 for the open group. There was no significant difference in overall survival or disease-free survival between the two groups ( χ2=0.39, 0.47, P>0.05). There was no significant difference in tumor recurrence rate or tumor recurrence site between the two groups either ( χ2=0.22, 1.86, P>0.05). Conclusion:After the learning curve, robotic pancreato-duodenectomy has non-inferior prognosis compared with open pancreatoduodenectomy.