BACKGROUND: Documents recorded that the correlation between micro emulsion Ciclosporin peak concentration (C_2) and area under curve was best with maximum individual difference. According to C_2, dose of Ciclosporin can be adjusted indMdually to decrease acute rejection and Ciclosporin toxicity, which has widely used in perioperative stage of renal transplanted recipients. However, some transplantation center still used tough concentration (C_0) to adjust the dose of Ciclosporin in stable stage of renal transplanted recipients. OBJECTIVE: To analyze the efficacy and safety of changing from monitoring C_0 to C_2 in stable stage recipients following renal transplantation. METHODS: Totally 65 patients with renal transplantation were enrolled in this study, including 31 males and 34 females, aged 20-57 (39.4±15.3) years. Within 3 months prior to this study, all patients did not suffered from rejection, and their serum creatinine and urea nitrogen were stable (creatinine ≤180 μmol/L). They were in stable stage after renal transplantation. Their period of transplantation and function of allograft were recorded. Their C_0 and C_2 of Ciclosporin were assayed. According to the target C_2 value 500-600 μg/L, the patients were prospectively and randomly divided into 3 groups. In the high C_2 group (n=17), the dose of Ciclosporin was decreased. In the target C_2 group (n=23), the dose of Ciclosporin was remained. In the low C_2 group (n=25), the dose of Ciclosporin was increased. All of the patients were followed-up for 12 months. The grafts function and the complications of heart, lung and brain were compared. RESULTS AND CONCLUSION: According to the target concentration of Ciclosporin C_2, the dose of Ciclosporin in the high C_2 group was decreased by 575.0 mg. The Creatinine and urea nitrogen of 88% patients were stable, while blood pressure, blood fat and blood uric acid decreased in parts of patients. In the target C_2 group, the levels of creatinine, urea nitrogen, Co and C_2 of patients were stable, no complications of heart, lung and brain occurred. According to the target concentration of Ciclosporin C_2, the dose of Ciclosporin in low C_2 group was increased by 755.0 mg. The creatinine and urea nitrogen of 84% patients were stable. All of the patients were no complications of heart, lung and brain. It is safe and effective to adjust Ciclospori dose under C_2 monitoring according to the target peak concentration (500-600 μg/L) in most stable stage recipients following renal transplantation.

OBJECTIVETo observe the clinical efficacy of treating chronic persistent bronchial asthma (CPBA) children with abnormal myocardial enzyme spectrum (AMES) by Yupingfeng Powder (YP) combined routine therapy.

METHODSFrom January 2010 to December 2012, 156 CPBA children patients with AMES were randomly assigned to the treatment group (80 cases) and the control group (76 cases). All patients received routine treatment (inhaled corticosteroids and/or leukotriene regulator). Besides, those in the treatment group took YP. The treatment duration was 3 months. The scores of children asthma control test (C-ACT), pulmonary function (FEV,% and PEF%), myocardial enzyme spectrum were observed before and after treatment, and 3 months before and after treatment. The myocardial enzyme spectrum of 40 healthy children at the baby clinics during the same period were recruited as the control.

RESULTSCompared with the control group, creatine kinase isoenzyme (CK-MB), creatine kinase(CK), and lactate dehydrogenase (LDH) increased in the two treatment groups (P <0.01), but there was no statistical difference in AST (P >0.05). Compared with before treatment in the same group, CK-MB, CK, LDH, and AST decreased in the treatment group after treatment and 3 months after treatment (P <0.01). CK-MB, CK, LDH, and AST decreased in the control group 3 months after treatment (P <0.01, P <0.05).Compared with after treatment, CK decreased in the control group 3 months after treatment (P <0.01). C-ACT score, FEV(1),%, and PEF% all increased in the two groups after treatment and 3 months after treatment (P <0.01, P <0.05). Compared with after treatment in the same group, CK decreased in the control group 3 months after treatment (P <0. 01). Compared with the control group in the same period, post-treatment CK-MB and CK decreased (P <0. 01, P <0. 05), while post-treatment C-ACT score, FEV, %, and PEF% increased (P <0.05) in the treatment group (P <0.05).

CONCLUSIONYP could strengthen specific and non-specific immunity of the organism, and improve clinical symptoms and the level of myocardial enzyme spectrum.

Asthma ; therapy ; Child ; Chronic Disease ; therapy ; Creatine Kinase, MB Form ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; L-Lactate Dehydrogenase ; metabolism ; Myocardium ; enzymology

Objective To investigate the effect of cyclosporine on matrix metalloproteinase-3 (MMP-3)’ s genetic expression on bladder cancer in rats induced with BBN and its clinical significance.Methods Twenty SD rats were divide into experimental group or control group randomly.Ten samples of SD rats bladder cancer induced with BBN and cyclosporine simultaneously and 10 samples of SD rats bladder cancer induced with BBN only as control were used to observe the effect of cyclosporine on MMP-3’ s genetic expression.Real time RT-PCR and immunohistochemistry stain were used to analyze MMP-3 mRNA and protein levels of bladder cancer in rats respectively.Results The MMP-3 mRNA median expression were 7.6 (4.2-9.1) in experimental group and 4.7 (2.8-7.7) in control group.The MMP-3 protein expression were 1 case with (-),4 cases (+),5 cases (++) in experimental group and 3 cases (-),4 cases (+),3 cases (++) in control group.The differences of MMP-3 mRNA and protein levels of bladder cancer between experimental group and control group were both significant (P ＜ 0.05).Conclusion Cyclosporine may stimulate the growth and development of bladder cancer through changing expression of some genes like MMP-3,and MMP-3 maybe become one of the targets of chemoprevention for post-transplantation bladder cancer.

Objective To investigate the effect of cyclosporine on signal transducer and activator of transcription 1 (STAT1) genetic expression on bladder cancer in rats induced by BBN and its clinical significance.Methods Twenty SD rats were divide into experimental group or control group randomly.Ten samples of SD rats bladder cancer induced with BBN and cyclosporine simultaneously as experimental group,and 10 samples of SD rats bladder cancer induced with BBN only as control.Real time RT-PCR and immunohistochemistry stain were used to detect STAT1 mRNA and protein level expressions of bladder cancer in rats respectively.Results The STAT1 mRNA median expression fold was 4.5 (2.1-6.6) in experimental group and 5.6 (3.4-8.5) in control group.The STAT1 protein expression were 5 cases with (-),3 cases (+),2 cases (++) in experimental group and 0 case (-),5 cascs (+),5 cases (++) in control group.The expression of STAT1 mRNA and protein level of bladder cancer between experimental group and control group were both significant different (P ＜ 0.05).Conclusions Cyclosporine may stimulate the growth and development of bladder cancer through changing expression of some genes like STATI,and STAT1 maybe become one of the targets of chemoprevention for post-transplantation bladder cancer.

ObjectiveTo investigate DNA loads and risk factors of BK virus infection in renal transplant recipients.MethodsWe developed a real-time PCR assay to quantitate BK virus loads in 80 patients receiving renal transplantation in our center,and correlation between the BK virus load and clinical course was analyzed.BK virus loads were measured in urine and plasma. Epidemiological features and risk factors of BK virus infection were analyzed.ResultsThe positive rate of BKV viruria and viremia in 80 renal recipients was 37.5％ (30/80) and 8.75％ (7/80),respectively.BKV loads were higher in renal allograft recipients whose age was more than 50 years old.BKV loads were observed in urine and plasma (compared with group whose age was less than 50 years,P=0.017 and 0.05,respectively).BKV DNA copies were higher in group Tac than that in group CSA (P＜0.05),and the peak of BKV load in serum appeared at14th and10th month after transplantation,respectively,but the peak in urine was ahead of that in serum,appeared at 2nd and 8th month,respectively.ConclusionSerial measurement of BKV viral loads by quantitative PCR is a useful tool in monitoring the course of BK virus infection.The ages of recipients (＞50 years) and using Tac + MPA can reactivate BK virus and then result in BKVAN in renal transplant recipients. Intensive BKV monitoring is necessary for these recipients.

Objective To investigate the signal transducer and activator of transcription 1(STAT1) and matrix metalloproteinase 3(MMP3)′s genetic expressions and their clinical significance on urothelial carcinoma after renal transplantation. Methods Fifty-one patients with urothelial carcinoma were recruited in this study. Sixteen of them who had renal transplant were in the experimental group and 35 of them without renal transplant were in the control group. All the cases had been proved postoperatively having transitional cell carcinoma by histopathological study. The human genome oligo arrays were used to analyze the gene expression spectrum of urothelial carcinoma after transplantation, aiming the STAT1 and MMP3's expression. Real time RT-PCR and immunohistochemical staining were used to compare the differences in the 2 groups. Results The experimental group showed that there were 35 genes up-regulated compared with the control group. Of them, 23had known gene function or partly known, and 12 had unknown gene function. There were 76 genes down-regulated. Of them, 46 had known gene function or partly known, and 30 had unknown gene function. After pathway analysis of the differentially expressed genes, there were 23 groups of pathways which had significant differences (P＜0.05), referring to the aspects of immunosuppressive and tumor growth. The levels of STAT1 and MMP3 expressions had significant differences between the 2groups(P＜0.05)as well. Conclusions The differential expression of urothelial tumor genes is obvious between patient who has had renal transplant and who has not. There are many aspects that are related to the tumor's growth like signaling pathways regulating proliferation, apoptosis of tumor cells, tumor angiogenesis and the tumor metastasis potential. STAT1 and MMP3 maybe become the targets of chemoprevention for post-transplantation urothelial carcinoma.

Objective To study the clinicopathologic features of post-transplant lymphoproliferative disorders (PTLD) following renal transplantation.Methods Four cases of PTLD following renal transplantation were studied and relevant literatures were reviewed.Results All the 4 cases had received 3-drug-immunosuppression after transplantation.The duration between renal transplantation and diagnosis of PTLD was 5-112 months,averagely 34 months.The patients were suffered from infective monocytic hyperplasialike PTLD,plasmacytic hyperplasialike PTLD,polymorphic PTLD and monomorphic PTLD respectively in morphology and had no specific symptoms.All the patients received therapy with dosage reduction of immunosuppressants and some received rituximab or chemotherapy.The case of monomorphic PTLD died in a short time after diagnosis.Conclusion PTLD is a lymphoproliferative disease with distinctive morphologic and clinical characteristics.The main treatments include the dosage reduction of immunosuppressive agents,biotherapy and chemotherapy.The prognosis of monomorphic PTLD is poor.

Objective To evaluate the feasibility of interstitial implantation of ~(125)I seeds for malignant tumor at the Head and Neck. Methods From Oct 2006 to Oct 2008,26 patients received interstitial implantation of ~(125)I seeds in our hospital because of recurrent or metastatic malignant tumors at the head or neck after surgery or chemotherapy. ~(125)I seeds were implanted into the tumor tissues under guidance of CT. Results The operation was completed in all the patients. A median of 23 seeds (12～54) were implanted in each case. No complications, such as hemorrhage, infection, or seed migration, occurred in the patients. The patients were followed up for 3～24 months. During the period,the rate of local control was 54% (15/28) at 3 months,72% (18/25)at 6 months,47% (11/23)at 12 months,and 37% (6/16)at 2 years. Conclusion Interstitial implantation of '2!I seeds is feasible for ecurrent or metastatic tumor at the head or neck with a good short - term outcome.

Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma (TCC) in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation.The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33. 0 months.Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis (n = 4), pure native ureter (n = 9), and pelvis combined with ureter (n = 19). Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in 11 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases.Patients were followed up for 26. 8 ± 25. 1 months. One patient died of lung metastasis. (One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.

Objective To explore the expression of anti-MICA antibodies and evaluate its influence on acute rejection and renal function in early period after renal transplantation. Methods A total of 29 sensitized subjects (PRA＞20 %) were enrolled in this study. All the patients underwent protein A immunoabsorption treatment and the expression of anti-MICA antibodies was detected before and after treatment. Triple immunosuppressive regimen consisting of tacrolimus, mycophenolate mofetil (MMF) and steroid was given to prevent graft rejection. The correlation between the expression of anti-MICA antibodies and acute rejection or serum creatinine (SCr) level was analyzed.Results The expression of anti-MICA antibodies was detected in 8 candidates (27. 6 % ,8/29) ,and 6 kinds of anti-MICA antibodies simultaneously expressed were found in one individual, 3 kinds in one case,and sole kind in 6 patients. There was no significant difference in acute rejection rate between positive anti-MICA antibodies group and negative group [37.5 % (3/8) vs 38. 1% (8/21), P＞0.05). The positive expression rate of anti-MICA antibodies in the recipients with PRA ≥40% was higher than that in those with PRA ＜40% [43. 8 % (7/16) vs 7. 7 % (1/13),P＜0.05]. The SCr level in patients positive for anti-MICA antibodies was markedly higher than that in those negative anti-MICA antibodies at the 1st week postoperatively ( 135.4 ± 21.4 vs 108. 6 -+ 31.6 μmol/L, P＜0.05). The SCr level in the patients with positive anti-MICA antibodies, however, was reduced to the normal range at the 2nd week after surgery (P＞0.05). The levels of anti-MICA antibodies were continuously decreased in the candidates undergoing protein A irnmunoadsorption treatment. Conclusion Higher expression of anti-MICA antibodies exists in sensitized recipients and possesses an influence on the recovery of renal function in early postoperative period. Protein A immunoadsorption can eliminate anti-MICA antibodies effectively in sensitized recipients.