OBJECTIVE: To evaluate the association between Cystatin C levels change and the clinical outcomes of critically ill patients.METHODS: There were altogether 4642 patients in intensive care unit(ICU)of West China Hospital of Sichuan university from 28 th August 2009 to 16 th April 2010,and their general conditions were recorded,including sex,age,and being with or without diabetes mellitus;then the database was established accordingly.The patients were divided into four groups according to the change of Cys C values in ICU:high increase(>1 mg/L),slight increase(≤1 mg/L),high decrease(>1 mg/L)and slight decrease(≤1 mg/L).The difference in 30-day mortality in patients were compared.The patients were followed up for 8 years.RESULTS: One thousand and thirty-six patients were included in this study,272 cases died within 30 days,with the highest in patients of the group with high increase of Cystatin C(77.9%),followed the high-decrease group(33.3%);the mortality rate of group with slight decrease was the lowest among the four groups(16.5%).The 8-year survival of 764 patients who did not die within 30 days was 54.58%.CONCLUSION: The change of Cystatin C value is closely related to the 30-day mortality of critically ill patients.The lowest 30-day mortality of critically ill patients is the group with slight decrease of Cystatin C.

Objective To summarize the experience of long-term survival in patients after simulta- neous kidney-pancreas transplantation(SKPT)with modified enteric drainage(ED).Methods From October 2001 to July 2004,6 patients with end-stage renal disease due to Type 1 diabetes underwent SKPT with modified ED,ie,side-to-side anastomosis between the duodenum of donors and jejunum of recipients. The medication regimen included:mycophenolic acid 500 mg and tacrolimus 2 mg before operation;methyl- prednisolone(MP)1.0 during operation;and 2-dose anti-IL-2 receptor monoclonal antibody(2 cases)or antihuman thymocyte globulin(ATG)(4 cases)for immune induction therapy;MP was used on the first 3 d after transplantation,triple immunosuppressive therapy(tacrotimus,mycophenolic acid and prednisone)was used on the second d after transplantation.Anticoagulants such as low molecular heparin or alprostadil were used for 7-10 d to prevent thrombosis in pancreas graft.Somatostatin was used as prophylaxis for graft pan- creatitis.Ganciclovir was used to prevent cytomegalovirus infection when renal graft gradually recovered 3 to 5 d after transplantation.The follow-up was from 1 year and 3 months to 4 years and 1 month.Results Transplantation was successful in all 6 cases.The blood sugar levels were 6-16 mmol/L.Low-dose insulin was used for 5-10 d,then the blood sugar levels returned to normal range.One of 6 patients experienced nephrotoxicity because of high tacrolimus blood concentration at 7 d after operation;after 3 dialyses and re- duction of tacrolimus dose,the renal allograft regained normal function.Three cases experienced alimentary tract hemorrhage at 14,20 and 22 d,respectively,after operation;the bleeding was stopped after treatment. There were no complications such as pancreatic fistula,intestinal fistula and thrombosis early after operation. All the patients are now alive,specifically,1 survived over 4 years,3 over 3 years,1 over 2 years,and 1 over 1 year.All had normal blood sugar free of insulin use.Five cases had normal renal graft function,with normal sCr,and 1 had sCr＞400?mol/L. Two cases were admitted to hospital due to upper respiratory infection and furuncles in the skin of head 6 months and 2 years,respectively,after operation.They were both cured.No complications such as urinary infection,metabolic acidosis and dehydration occurred.Conclusions SKPT is effective for the treatment of end-stage renal disease due to Type 1 diabetes.SKPT with modified ED are relatively simple with physiological compatibility and fewer complications.High quality of donated organs, HLA matching,pancreatic drainage pattern,rational periopcrative medications and infection late after trans- plantation are important factors affecting the long-term survival of the patients.

OBJECTIVETo develop a method for determining artemisinin in rat plasma in vivo.

METHODHPLC-MS was adopted. Estazolam was selected as an internal standard (I.S.). The sample and I.S. were extracted using methyl tertbutyl ether and measured at m/z of 305 and 296, respectively.

RESULTWithin the linear range of 5-500 microg x L(-1), the ratio of artemisinin's peak area and I.S. peak area and the concentration showed good linearity, thus the minimum concentration was set to be 5 mictrog x L(-1).

CONCLUSIONThe methodology proved that the method is so suitable for determining the drug concentration in rat blood that it can be used for studying pharmacokinetics in animals.

Animals ; Artemisinins ; pharmacokinetics ; Chromatography, High Pressure Liquid ; Mass Spectrometry ; Rats

OBJECTIVETo identify a novel human leukocyte antigen (HLA) allele in Chinese and investigate its inheritance in the family.

METHODSExceptional reaction pattern was detected in HLA-B locus in HLA typing using Luminex DNA polymerase chain reaction with sequence specific oligonucleotide probe hybridization (PCR-SSOP) assay. A confirmatory test for the novel HLA allele was performed by DNA sequencing based typing of the proband's family.

RESULTSThe DNA sequence was confirmed to be a novel HLA B allele. There were 7 nucleotides which differed from the closest matching HLA B*40:06:01 at positions 302(G to A), 309(G to C), 311(A to C), 313(C to G), 314(T to C), 317(G to T), and 319(G to C) in exon 2, which resulted in 5 amino acid changes at codon 101 (Ser to Asn), 104 (Asn to Thr), 105 (Leu to Ala), 106 (Arg to Leu), and 107 (Gly to Arg), respectively. Family investigation indicated that the novel allele was transmitted from the proband's father.

CONCLUSIONA novel HLA B allele was identified and officially named as HLA-B*40:96 (GenBank accession No. FJ374890) by the WHO Nomenclature Committee for Factors of the HLA System.

Alleles ; Base Sequence ; Female ; HLA-B Antigens ; genetics ; Haplotypes ; Histocompatibility Testing ; Humans ; Molecular Sequence Data ; Pedigree ; Sequence Alignment

OBJECTIVETo investigate the displacement, the position of rotation center and the stress distribution of PDL under different loading force system (Moment/Force, M/F) by simulating clinical loading force system.

METHODSA three-dimensional finite element model of upper central incisor, which consists of 945 isoparametric elements and 1,245 nodes was developed. The displacement, the position of the rotation center and the stress distribution of PDL were analyzed under 13 types of loading force system.

RESULTS1. Different force system led to different types of tooth movement. When M/F= -9.15:1, -10.30 - -10.50:1 and -10.90:1, it brought the result of controlled tipping movement, the bodily movement and the root movement; 2. The graph of the center rotation was a hyperbolic asymptotic line: Mx/Fy = -10.50 (horizontal axis) and L = 6.75 (vertical axis). Moreover, a little change of M/F between -9.15 and -10.90 led to apparent change of the position of rotation center. 3. The maximum strain and stress during the tipping movement were 1.47 x 10(-2) MPa and -2.81 x 10(-2) MPa, and during the bodily movement the results were 1.10 x 10(-2) MPa and -1.86 x 10(-2) MPa, while during the root movement were 0.96 x 10(-2) MPa and -2.58 x 10(-2) MPa.

CONCLUSION1 . Different force system (M/F) leads to different types of tooth movement. 2. It is necessary to adjust the force system accurately to obtain prescient tooth movement, especially when M/F changes between -9.15:1 and -10.90:1. 3. This study suggested that the tooth movement style and the force system (M/F) should be controlled to protect the periodontal tissue.

Dental Stress Analysis ; Finite Element Analysis ; Humans ; Incisor ; physiology ; Models, Biological ; Periodontal Ligament ; physiology ; Tooth Movement Techniques

This study was aimed to analyze the polymorphism of HLA-A, B, DRB1 alleles at high-resolution level in Han population from southern area of Shandong province in China. 688 randomly selected, unrelated and healthy individual from southern area of Shandong province were genotyped for HLA-A, -B and HLA-DRB1 loci by PCR-SBT. Then, allelic and haplotypic distributions of HLA-A, B and DRB1 were estimated by maximum likelihood estimation method using Arlequin 3.0. The results indicated that a total of 31 HLA-A, 63 HLA-B and 39 HLA-DRB1 alleles were identified in Han Population from southern area of Shandong province. Six HLA-A alleles were found with a frequency greater than 0.05 (A*24:02, *30:01, *11:01, *02:01, *33:03 and *02:06), with a cumulative frequency of 0.7223. For HLA-B locus, there were also six alleles which had a frequency higher than 5% (B*1302, *4403, *5101, B*4601, *1501 and *5801), representing 0.4432 of the all alleles in the population. And four HLA-DRB1 alleles were defined as predominant (DRB1*0701, *1501, *0901and *0803), accounting for 0.5453 of the defined alleles. The most common three-loci haplotype was A*30:01-B*13:02-DRB1*07:01 (0.1151) and the most frequent two-loci haplotype were A*30:01-B*13:02 (0.1303), A*30:01-DRB1*07:01 (0.1157) and B*13:02-DRB1*07:01 (0.1307). It is concluded that the allelic and haplotypic diversities of HLA-A, -B and HLA-DRB1 at high-resolution in Han population from southern area of Shandong province in China provide useful information for HLA matching in transplantation and diseases-associated study in this population.
Alleles ; Asian Continental Ancestry Group ; genetics ; China ; Female ; Gene Frequency ; Genetics, Population ; HLA-A Antigens ; genetics ; HLA-B Antigens ; genetics ; HLA-DRB1 Chains ; genetics ; Haplotypes ; Humans ; Male ; Polymorphism, Genetic

Objective To evaluate the efficacy and safety of memantine in the treatment of patients with Alzheimer' s disease (AD).Methods This was a 16-week,multi-center,randomized,double blind, placebo-controlled clinical trial (Study 10116).A total of 258 AD patients (MMSE score 5—18) were randomized in a 1:1 ratio into either memantine 10—20 mg/day (MEM,n=128) or placebo (PBO,n= 130) group for 16 weeks.Efficacy was primarily assessed in terms of changes of severe impairment battery (SIB) score in patients from baseline up to SIB assessment in the 16th week (16-week completers set, CS16).While ehanges of MMSE,ADCS-ADL_(19),and NPI (neuropsychiatric inventory) were evaluated as secondary efficacy parameters on both CSI6 and full-analysis set (FAS).Safety was assessed by physical examination,lab assays,ECG,and adverse events.Results 236 subjeets (CS16:MEM n=117,PBO n=119) were eligible for the efficacy assessment.No statistically significant difference between the treatments was observed on the primary and seeondary efficacy analysis,although both treatment groups had a slight increase from baseline in SIB total score.Post hoe evaluation of the data identified two bias factors that had a significant impact on the results of the pre-protoeol specified primary and secondary analyses.In a re-analysis of the data (CS16_(modified),MEM n=94,PBO n=95) excluding patient data affeeted by these factors,memantine-treated patients showed a statistically significant improvement related to placebo in the 16th week on the SIB (MEM 2.2 vs PBO 0.3,P=0.04),MMSE (MEM 1.0 vs PBO 0.1,P=0.03),and ADL (MEM 0.1 vs PBO-1.6,P=0.02) scales,indicating that memantine improved the cognitive function of AD patients and stabilized the activity of daily life.Memantine was well tolerated with an adverse event profile similar to that of placebo.Conclusion This study provides further support for pre-existing data,showing that memantine is efficacious,safe,and well-tolerated in patients with moderate to severe AD.

OBJECTIVETo review the clinical experiences concerning simultaneous liver-kidney transplantation in polycystic kidney and hepatic disease with kidney and liver failure.

METHODSThis study involved 8 cases of simultaneous liver-kidney transplantation in polycystic kidney and hepatic disease with kidney and liver failure. There were 5 male and 3 female patients, aged from 41 to 67 years old with a mean of 52.8 years old. Six cases transplanted kidney after liver with orthotopic liver transplantation, and 2 cases transplanted liver after kidney with piggy-back liver transplantation. The acute rejections, complications, liver function, kidney functions, and survival rates of patient/liver/kidney were recorded.

RESULTSWithin the follow-up of 28 to 65 months, all 8 patients are still alive with normal liver and kidney functions: 2 living more than 5 years, 2 living more than 4 years and 4 living more than 2 years. 2 cases of pleural effusion and 1 case of pneumonia were complications after operation, which had been cured successfully. No acute rejection of allograft was observed.

CONCLUSIONSSimultaneous liver-kidney transplantation is a safe and effective treatment for polycystic kidney and hepatic disease with kidney and liver failure.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Kidney Transplantation ; Liver Diseases ; complications ; surgery ; Liver Failure ; etiology ; surgery ; Liver Transplantation ; Male ; Middle Aged ; Polycystic Kidney Diseases ; complications ; surgery ; Renal Insufficiency ; etiology ; surgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo summarize the features of pulmonary infection (PI) in kidney transplant (Ktx) and liver transplant (Ltx) recipients for effective control measures.

METHODSA retrospective analysis was conducted among Ktx recipients and Ltx recipients with PI during the period from Jan 2004 to Dec 2008. The clinical data concerning the infection was compared.

RESULTSForty-five Ktx recipients and 23 Ltx recipients developed PI after the transplantation. The incidence of PI was 7.4% and 56.1% in (P<0.001), respectively, with severe PI occurring in 2.6% and 46.3% of the recipients (P<0.001). The median time from PI diagnosis to transplant was 230 days (29-1080 days) and 4 days (2-104 days) (P<0.001), the case-fatality rate for PI was 6.7% and 17.4% (P=NS), and the mortality rate was 0.5% and 9.8% (P<0.001) in Ktx and Ltx recipients, respectively; Gram-negative organisms were the most common in both Ktx and Ltx recipients, but Ltx recipients had significantly higher incidence of multidrug-resistant bacteria (12.9% vs 37.0%, P=0.005).

CONCLUSIONThe knowledge of PI after the transplantation will benefit appropriate prophylactic and empirical treatment to improve the survival of Ktx and Ltx recipients.

Adult ; Female ; Humans ; Kidney Transplantation ; adverse effects ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Pneumonia ; epidemiology ; microbiology ; virology ; Retrospective Studies

OBJECTIVETo identify a novel HLA DRB1 allele in a Chinese leukemia family.

METHODSA new HLA-DRB1 allele was initially detected by polymerase chain reaction-sequence specific primer and unusual reaction pattern by Luminex RSSO, then DNA sequencing was performed to identify the sequence of the novel allele.

RESULTSThe DNA sequencing revealed the presence of the new allele which differs from the closest matching HLA-DRB1*120201 by a single nucleotide substitution at position (341 C > T in exon 2), resulting in an amino acid change from Ala to Val at coden 85.

CONCLUSIONA novel allele was confirmed by DNA sequencing and has been designated HLA-DRB1*1219 by the WHO Nomenclature Committee.

Alleles ; Amino Acid Sequence ; Base Sequence ; HLA-DR Antigens ; genetics ; HLA-DRB1 Chains ; Humans ; Molecular Sequence Data ; Mutation ; Sequence Analysis, DNA