BACKGROUND:Pulmonary infection is the main complication after kidney transplantation, and its onset and morbidity may be related to conventional oral drugs after kidney transplantation.
OBJECTIVE:To analyze the effect of methylprednisolone instead of prednisone on severe pulmonary infection after kidney transplantation.
METHODS:Clinical data of 58 patients with severe pulmonary infection after kidney transplantation were retrospectively analyzed. First, according to the characteristics of post-onset patients and lung CT findings, broad-spectrum antibiotics and anti-fungal treatment were adopted, and subsequently targeted therapy, that is, withdrawal or adjustment of dosage and combination regimen of immunosuppressive agents, was employed depending on etiology, fungi and virus detection results. Among the 58 patients, 28 patients were injected methylprednisolone, and 30 patients took oral prednisone. Hyoxemia correction, support therapy and immune replacement therapy were applied.
RESULTS AND CONCLUSION:Thirty-nine of 58 patients (67.2%) were positive for pathogens, including 7 cases of simple bacterial pneumonia, 4 cases of fungal pneumonia, 3 cases of simple cytomegalovirus infection, and 25 cases of mixed infections (5 cases of multiple bacterial infections, 17 cases of fungal and bacterial co-infections, and 3 cases of fungi, bacteria and cytomegalovirus co-infections). Patients subjected to methylprednisolone treatment spent shorter time to recover their temperature than those undergoing oral prednisone (P<0.05). In addition, creatinine fluctuation range in the methylprednisolone group was less than that in the prednisone group (P<0.05). The results showed that intravenous injection of methylprednisolone may accelerate absorption of inflammatory exudate in the lung and shorten treatment time.

Objective Based on detection of the soluble LAIR-1 (sLAIR-1) and sIL-2R in the bile from recipient after liver transplant, the role of sLAIR-1 and sIL-2R in graft acute rejection were analyzed. Methods Bile sLAIR-1 level and sIL-2R were determined by double mAb sandwich enzyme linked immunosorbent assay in 55 cases of liver transplantation. Results In 22 recipients with normal graft function, sLAIR-1 and sIL-2R were detected at low level in the bile. In the 29 cases of liver acute rejection (AR), significant increase of bile sIL-2R level was detected on the lst and 2nd d before final diagnosis. With the effective methylprednisolone pulse therapy, sIL-2R level was decreased significantly on the 3rd d. On the other hand, remarkable increase of bile sLAIR-1 was found on the lst,2nd and 3rd d before final diagnosis. After of methylprednisolone pulse therapy for 3 d, bile sLAIR-1resturned to the control level. Conclusion Both bile sIL-2R and sLAIR-1 are detected at high level in the recipients suffering from liver acute rejection. The level of bile sLAIR-1 changes dramatically and responsively according to liver acute rejection. Therefore, detecting these two markers synergistically may be a promising monitor for rejection after liver transplantation.

BACKGROUND: Hepatic myelopathy results from liver disease, which lacks of effective cure method. Liver transplantation has attempted to cure this disease; however, the long-term therapeutic effect is rarely reported. OBJECTIVE: To explore the long-term therapeutic effect of liver transplantation in patients with hepatic myelopathy. METHODS: The clinical data of 2 patients with hepatic myelopathy, who underwent orthotopic liver transplantation, in August 2002 and November 2004, at the 309 Hospital of Chinese PLA, were analyzed retrospectively. The time of follow-up was 18 and 43 months, respectively. The muscle strength of double lower limbs in 2 patients was assessed prior to and after operation. RESULTS AND CONCLUSION: Two patients recovered well at 4 weeks after transplantation, the clinical symptom and physical signs of patients were improved obviously, the blood routine examination and other biochemical index were normal,and the function of transplanted kidney was normal. Two patients discharged at 6 weeks after transplantation. Patient 1 could stand for a long time at months 6 after transplantation, walked slowly with the supporter after 12 months and without the supporter at 43 months. The muscular strength of two lower limbs was grade 4. And the liver function was normal. Patients 2 could move his lower limbs in bed at months 6 after transplantation, walked with the supporter at 18 months. The muscular strength of two lower limbs was grade 3. The liver function was normal. It demonstrated that liver transplantation is beneficial to control hepatic myelopathy and recover muscular strength of two lower limbs. It is a newly developed, effective curing method for treating hepatic myelopathy. However, the numbers were small with short time observation, thus, the long-term therapeutic effect still need to be explored.

Objective To investigate the differentiation of neuroendocrine component (NEC) in colorectal adenocarcinoma in relation to its significance by comparing the outcome between patients with or without NEC.Methods The paraffin sections from patients with pathologically confirmed colorectal adenocarcinoma were retrospectively collected and screened for those with NEC by morphological examination and immunohistochemistry with neuroendocrine markers.Control patients (n=54) without NEC were selected from colorectal cancer database and 2: 1 matched on the basis of clinical features with NEC positive patients (n=27).Relative analysis was performed between two groups.Results With a median follow-up of 72 months,the 5-year disease free survival was 58.0% (16/27) in NEC positive group and 79.1% (43/54) in control group (P=0.036).Similarly,the 5-year cancer-specific overall survival was significantly lower in NEC positive group than in control group (58.3% versus 81.1%,P=0.037).Cox regression showed that the 5-year cumulative risks of disease recurrence and cancer-caused death in NEC positive patients were 2.38 and 2.41 times higher than those in control patients,respectively.Conclusions NEC appears to bear a poor prognosis in patients with colorectal adenocarcinoma.

Objective To study the effect of Shaoyaozhitong Mixture on stageⅢ-Ⅳendometriosis, and explore its mechanism. Methods Ninty-five cases of stageⅢ-Ⅳ endometriosis were randomly divided into three groups. The traditional Chinese medicine (TCM) group (31 cases) was treated with Shaoyaozhitong Mixture, the GnRHa group (31 cases) was treated with Triptorelin Acetate for Injection, while the expectant group (33 cases) received no medications. The changes of CA125, TNF-α and VEGF levels, visual pain score and SF-36 score, total effective rate, pregnancy and recurrence were compared. Results There were significant increases in CA125, TNF-α and VEGF levels, visual analogue pain score and SF-36 score in all the three groups after treatment (P<0.05). The decline of CA125, TNF-αand VEGF levels and visual analogue pain score in TCM group and GnRHa group was significantly faster and greater than that of the expectant group (P<0.05). The total effective rates of TCM group was 83.9%(26/31), GnRHa group was 87.1%(27/31), and expectant group was 60.6%(20/33), TCM group and GnRHa group were superior to the expectant group, respectively (P<0.05). The pregnancy rate was higher and recurrence rate was lower in TCM group and GnRHa group than that of expectant group, but there was no statistical difference (P>0.05). Conclusion Shaoyaozhitong Mixture is effective in treating endometriosis by inhibiting the growth of ectopic endometrium.

Objective To evaluate the storage performance of storage bags for apheresis platelets produced by Shandong Weigao Group Medical Polymer Co .,Ltd ( experimental bags ) with Trima set platelet storage bags produced by the U .S. Gambro BCT as the control .Method One unit of apheresis platelets was divided into two equal parts , added to control blood bags and experimental blood bags respectively .All samples were stored at ( 22 ±2 )℃ with consecutive oscillation . The platelets′count, mean volume, aggregate activity (ADP, THR), pH, glucose, lactate concentration, lactate dehydro-genase concentration , hypotonic shock reaction , expression of CD62P and phosphatidyl serine on surface of cell membrane were detected at 0,3,5 and 7 d respectively.Results There was no significant difference in platelet quality after five days of storage between the experimental group and the control group (t-test, P>0.05).Conclusion Two types of platelet stor-age blood bags have similar storage performance for apheresis platelets .

Objective To investigate the clinical and molecular genetic changes in a Chinese family with oculopha?ryngeal muscular dystrophy(OPMD). Methods We collected the clinical data of the familial members and blood sam?ples from all available 16 familial members, including the proband. The samples were analyzed using modified poly?merase chain reaction amplification and direct sequence analysis. Results Male OPMD patients initially presented with ptosis, followed by pronunciation difficulty, dysphagia and limb weakness whereas female OPMD patients initially pre?sented with swallowing difficulty. Genetic test revealed the abnormal expansions of the GCG trinucleotide repeat from GCG6 to GCG10 in PABPN1 gene in 10 familial members. Conclusions The genetic test and prenatal diagnosis is the key for the prevention treatment of oculopharyngeal muscular dystrophy. The ptosis of eyelid may be the initial symptom for the male patients of oculopharyngeal muscular dystrophy with (GCG)10 mutation.

Objective To establish a flow cytometric measurement of detecting minimal residual disease(MRD) according to the leukemia-associated immunophenotypes in children with acute lymphoblastic leukemia(ALL) and to explore the significance of MRD detection in ALL children for a individualized treatment. Methods A variety of four-color fluorescent antibody combinations were used to investigate the children's normal bone marrow. The normal bone marrow pattern at two-parameter plots was established to identify the residual tumor cells, seventy-five bone marrow samples from newly diagnosed ALL children were analyzed with four-color cytometry to determined the optimal combinations which can clearly distinguish the tumor cells from normal cells. The bone marrow samples were monitored with the combination panel in 60 patients at the end of induction therapy and follow-up treatment. Cytomorphology test, PCR amplification of 29 fusion genes as well as IgG and TCR gene rearrangements were performed simultaneously. Results Sixty-nine cases (92.0%) could be identified for effective antibody combinations to monitor MRD by four-color cytometry. Fusion genes or IgG and T cell receptor (TCR) gene rearrangements can be detected in 21 cases (28.0%) to monitor MRD by PCR. No MRD can be detected in 25 bone marrow samples at the end of induction therapy and follow-up treatment. Four-color cytometry could detect as low as 0.021%-4.130% residual leukemia cells. Conclusion MRD can be monitored by flow cytometry which is faster than PCR, and the sensitivity is superior to morphology method.

Objective To analyze the clinical techniques of renal artery control in laparoscopic donor nephrectomy.Methods 211 relative living renal transplantations were performed from June 2003 to June 2012,and 136 donors underwent laparoscopic donor living nephrectomy (LDN) since 2007.Forty donors were subjected to the Hem-o-lock clips for renal artery control by open surgery,87 donors to the Hem-o-lock clips for renal artery control by laparoscope,5 donors to the Endo GIA stapler for renal artery control by laparoscope,and 4 donors to the Hem-o-lock clips by laparoscope combined with hand-assisted suture transfixion for renal artery control.Results The warm ischemia time of renal artery control was shortest (1.1 ± 0.3 min) by Hem-o-lock clips in open surgery,and longest (3.2 ± 0.8) min by the Hem-o-lock clips with laparoscope.There was significant difference in the warm ischemia time of renal artery between open group and other groups,the differences (P＜0.05).The comparison of prognostic factors in the transplant renal outcome showed no significant difference among groups.The renal arterial stump-rrhexis-caused massive secondary bleeding occurred in 1 case subject to Hem-o-lock clips for renal artery control by laparoscope,with conversion to open surgery urgently,the operation was successful at last.Other renal artery control ways were all safe without any adverse reaction.Conclusion The warm ischemia time of renal artery control by Hem-o-lock clips in open surgery was shortest in laparoscopic donor nephrectomy.The renal artery control way by Endo GIA stapler in laparoscope or by Hem-o-lock clips with hand-assisted suture transfixion is safest.The utilization of Hem-o-lock clips should be careful in high risk population such as severe atherosclerosis etc.