Objective To evaluate the common causes of chronic cough and the diagnostic value of clinical symptoms,and provide evidences for empirical treatment.Methods The causes of patients with chronic cough were evaluated by a validated systematic diagnostic protocol.The characteristics of the cough timing,characters,incentives and associated manifestations of chronic cough with different causes were compared.Results A total of 160 patients with at least 8 weeks of chronic cough and normal chest radiographswere recruited from the Department of respiratory diseases of Yichang Central Hospital between Jan.to Dec.2009.The most common causes of chronic cough were cough variant asthma (CVA,n =72,45％ ),upper airway cough syndrome ( UACS,n =54,33.75％ ),eosinophilic bronchitis ( EB,n =14,8.75％ ),gastroesophageal reflux-related chronic cough ( GERC,n =9,5.63％ ),other etiologies ( n =11,6.87％ ).Significant differences were observed in different etiological subtypes.The incidence of nocturnal cough in CVA was 52.8％ ( 38/72 ),significantly higher than others types ; URCS patients manifested more day coughs,with 70.2％ postnasal drip syndrome and significantly more cases had the history of nasal diseases compared with other types.The specificity of cough associated with meals in GERC were 66.7％,and the regurgitation associated symptom in GERC were77.8％,significantly higher than other types.However no special syndromes were observed in EB patients.Conclusion All kinds of chronic coughs have specific symptoms.The spectrum of causes and clinical features of chronic cough are important in the diagnostic procedure of chronic cough.

Objective:To establish a method for the determination of salicylic acid in the compound sulfur ointments by ultra-per-formance liquid chromatography (UPLC). Methods:An Agilent ZORBAX SB-C18(250 mm ×4.6 mm,5 μm)column was used, the mobile phase was methanol-0. 1 mol·L-1 sodium dihydrogen phosphate (30∶70), the detection wavelength was 231nm, the column temperature was 35℃, the flow rate was 1. 0 ml·min-1 and the injection volume was 10μl. Results:The linear range of salicylic acid was 11. 96-59. 80 μg·ml-1(r=0. 999 9), and the average recovery was 99. 72%(RSD=1. 28%,n=9). Conclusion:The method is accurate, stable and specific, and suitable for the determination of salicylic acid in the compound sulfur ointments.

Objective To evaluate the efficacy of comprehensive treatment for liver cancer recurrence and metastasis after liver transplantation, and investigate the risk factors affecting the lifespan of patients with liver cancer recurrence and metastasis. Methods Of 29 patients with liver cancer recurrence and metastasis after liver transplantation, 11 patients in the comprehensive treatment group were treated by TACE, microwave coagulation, radiotherapy or hepatectomy, and the remaining 18 patients were classified into chemotherapy group. The differences in efficacy between the 2 treatment modalities were compared, and the factors influencing the patients' lifespan were analyzed. Results Compared with patients in the chemotherapy group, patients in the comprehensive treatment group had significantly longer lifespan after liver cancer recurrence and metastasis (t = 5. 617, P < 0.01). TNM staging, pathological classification, time of postoperative recurrence and metastasis and treatment method were the factors that influence the lifespan of patients with liver cancer recurrence and metastasis after liver transplantation (t =2.843, 3.061,22.781,5.617, P <0.01). Conclusions Comprehensive treatment could prolong the lifespan of patients with liver cancer recurrence and metastasis after liver transplantation. The efficacy of comprehensive treatment is superior to that of the chemotherapy.

Objective To evaluate the relevant causes of neurologic complications following liver transplantation.Methods 155 adult patients (131 males, 24 females) who received liver transplantation for the first time at Tongji Hospital between January 2005 and September 2009 were identified.Case notes were reviewed and demographic data, details of the liver disease, neurologic complications, MELD score and discharge information were recorded.Results Neurologic complications occurred following 36 transplants (23.2 %), The complications included mental symptoms in 15 cases (41.7 %), disorder of consciousness and action in 9 cases (25 %), and coma in 12 cases (33.3 %).Twelve percent patients with liver cancer experienced a neurologic complication, which was lower than for other transplant indications, like acute and chronic hepatic failure because of HBV infection (33.3 %, P＜0.01), inborn/metabolic disease (40 %, P＜0.05), and HCV Infection (25 %, P = 0.36).Patients who experienced a neurologic problem had significantly higher MELD score (for non-cancer patients:22.93 ± 8.21; for cancer patients:17 ± 5.4) than the other Patients (for non-cancer patients:18.33 + 8.47, P＜0.05; for cancer patients:13 ±3.4, P＜0.01).The rate of infection (36.1 %) and mortality (30.5 %) were significantly higher in patients with neurologic complications (P＜0.01).The levels of ALT, TBil, ALB, PT and the concentrations of serum sodium and chlorine had no impact on neurologic complications.Conclusion Neurologic complications are common in liver transplant recipients.These complications are related to primary disease and liver function before the operation, and increase the rate of infection and mortality.

Objective To evaluate the role of native ureter for the management of renal transplantation urological complications retrospectively.Method Twenty-six renal transplant recipients (18 males and 8 females) experienced the following urological complications:upper ureter injury,urinary leaks and moderate or severe ureteric obstructions secondary to ureterovesical anastomotic stricture.These complications have been managed with minimally invasive endourologic techniques or percutaneous nephrostomy as the first-line intervention.While endourologic treatment did not succeed,and the recipients have been treated with intraperitoneal open surgical correction.Urinary continuity was established by pyeloureterostomy or ureteroureterostomy using recipient native ureter.A pigtail ureteral stent was placed with the tip positioned in the pelvis of the graft and native bladder and removed after 4 to 6 weeks.Result The recipients were managed successfully during a follow-up period of 6 months to 6 years without occurrence of urological complications.One case underwent graft loss due to chronic rejection 5 years later postoperation,and the rest developed stable renal function with baseline serum creatinine.Conclusion Excellent outcomes have been achieved by the use of recipient native ureter for the management of urological transplant complications.This simple and efficient procedure should be considered as the superior choice for the recipients who experienced urological complications while less invasive endourologic techniques failed.

Objective To determine the long-term results after combined pancreas-kidney transplantation at a single-center institution.Methods Fifty-three consecutive patients with insulin-dependent diabetes mellitus and end-stage nephropathy were followed up for more than three years after combined pancreas-kidney transplantation. Immunosuppressive protocol consisted of tacrolimus ( TAC ),mycophenolate mofetil (MMF),and steroids,and antithymocyte globulin or anti-CD25 receptor mAb.The impact of different risk factors was analyzed on long term patient and graft survival.Results The 3-,5- and 8-year survival rate in recipients was 90.1％,89.1 ％ and 80.0％,respectively.The 3-,5- and 8-year survival rate of pancreas grafts was 84.9％,84.8％ and 60.0％,and that of kidney grafts was 83.0％,82.6％ and 53.3％,respectively.Principal causes of death were Infection (n =4),renal failure (n =2),cardiovascular events (n =1 ),and cerebrovascular accident (n =1 ).Graft failure for the pancreas was caused by death with a functioning graft (n =6),rejection (n =2),thrombosis (n =1 ) and pancreatitis (n =1 ).Graft failure for the kidney was due to rejection (n =9),and death with a functioning graft (n =9).Conclusion This series representing the largest experience with long-term follow up in China confirms an excellent long-term survival.Infection,rejection and surgical complication were the major risk factors leading to deaths and graft loss.

Objective To review the first case of paired-exchange kidney transplantation between two couples in China.Methods In April 2006,two cases of paired-exchange living kidney transplantations were successfully performed.Husband 1 in blood type O received a kidney donated from husband 2 in blood type O,while wife 2 in blood type A received a kidney from wife 1 in blood type A.Results The transplantation was performed smoothly.Renal graft in husband 1 functioned for 21 months,and the recipient died at 9th month due to infection.Graft survival and patient survival in wife 2 were 30 month and 31 month respectively.Conclusion Paired-exchange of living-related kidney donation and transplantation,as an effective pathway to resolve the shortage of organ,could be programmed with cautious medical guideline,ethical consideration and legal framework in China.

Objective To evaluate the effect of pediatric renal transplantation using donation after cardiac death (DCD).Methods The male DCD meeting Chinese standard Ⅲ (C-Ⅲ) was 49 years old,and the recipient with chronic renal failure was 14 years old.The right kidney of the donor was transplanted to the recipient.The renal artery and renal vein of the donor were end-to-side anastomoscd to the common iliac artery and common iliac vein of the recipient,respectively.The graft was transplanted into the fight iliac fosse.Warm ischemia time was 12 min,and cold ischemia time was 2 h.Immunity induction therapy was performed with basiliximab.Tacrolimus + mycophnolate mofetil + Pred were used as immunosuppressive regimen.Results The transplantation was done successfully.One day after operation,ALT was increased dramatically.The recipient was diagnosed as acute drug-induced liver injury.There was no occurrence of acute rejection and delayed graft function.The recipient was discharged one month after the operation,and followed up for 6 months with normal graft function.Conclusion Pediatric renal transplantation using DCD is effective and safe,even though the long-term effect still needs to be further observed.

Objective To summarize the effect of en bloc kidney transplantation (EBKT) from cardiac deceased infant donors into adult recipients and to share a new simplified EBKT technique.Methods Fourteen dual kidneys from infant donors (9 males,and 5 females) were transplanted into adult recipients (3 males,and 11 females).The donor ages ranged from 17 days to 8 months,and the recipient ages ranged from 19 years to 61 years.The recipients were categorized into 2 groups in terms of the microvascular surgical techniques.Case 1 to case 9 was given traditional techniques and case 10 to case 14 simplified techniques.In detail,the dual kidneys were recovered en bloc with the aorta and inferior vena cava.After splitting the rear wall of the donor aorta and inferior vena cava,suitable size of patches were made by cutting along the vascular openings of renal arteries and renal veins.We anastomosed the aorta patch to the external iliac artery in an end-to-side fashion.The donor inferior vena cava patch was anastomosed to the external iliac vein in an end-to-side fashion.The distal ends of ureters were implanted into the bladder separately.Results In traditional group,two cases underwent peri-operative graft loss because of renal artery thrombosis,and one patient died of pneumonia 16 days post-operation.During the follow-up period,graft loss was seen in 2 patients caused by irreversible drug-induced nephrotoxicity and donor-derived malignant tumor respectively.The mean serum creatinine level was 81.7 ± 27.4 μmol/L and eGFR level was 82.5 ± 22.2 mL/min/1.73 m2 in the other EBKT recipients at 24th week post-operation.In simplified group,no vascular complications post-operation occurred.Conclusion En bloc infant kidneys could be transplanted into adult recipients successfully with excellent graft function and survival outcome while censored perioperative patient death and surgical failure.Instead of traditional EBKT technique,simplified EBKT technique could decrease the incidence of surgical vascular complications and should be applied to more recipients.

OBJECTIVES:To evaluate the efficacy of rapamycin(RPM)oral liquid plus cyclosporine(CsA)on the preven?tion of early acute rejection after renal allograft.METHODS:20patients undergoing primary renal allografting were randomly divided into RPM trial group and Azathioprine(Aza)control group,10cases in each group,who were respectively assigned to receive CsA and adrenocortial hormones-based immunosuppression for6months,indexes including survival rates of recipients/kidneys,incidences of acute rejection and adverse reactions between2groups were compared.RESULTS:For the17patients who had finished6-month treatment,the survival rates(recipients/kidneys)were100%.Only2episodes of acute rejection occurred in one case in Aza group.Both groups had2cases of severe adverse episodes.CONCLUSIONS:The combined therapy pf RPM plus CsA is effective in the prevention of acute renal allograft rejection,and it can maintain renal function at a good level.Nevertheless,it may increase the hepatotoxicity of CsA.