Objective To explore the effect of MICA-Ab expression on the prognosis of sensitized renal transplantation recipients.Methods A total of 51 sensitized recipients (PRA more than 20%) in our hospital from August 2007 to April 2010 were enrolled in the study.In these patients,29 cases received protein A immunoadsorption and detection of MICA-Ab was performed before and after protein A immunoadsorption.Other 22 patients received MICA-Ab detection when they were hospitalized.Associations of PRA,HLA-matches,acute rejection,and serum creatinine of postoperative week 1 and week 4 with MICA-Ab were analyzed retrospectively.Results Sixteen recipients (31.4%) had positive MICA-Ab expression but their acute rejection rate was not higher as compared to the patients with negative MICA-Ab expression.Recipients with PRA＞40% showed higher expression level of MICA-Ab than recipients with PRA≤40% (P≤0.05).HLA-match did not show influence on MICA-Ab expression.MICA-Ab positive group had no higher serum creatinine level than negative group in postoperative week 4.MICA-Ab level decreased significantly after protein A immunoadsorption.Conclusions MICA-Ab expression increases in the sensitive recipients but does not influence the prognosis.Protein Aimmunoadsorption can eliminate MICA-Ab effectively in sensitized recipients.

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.

Objective To observe whether the intravenously transplanted homologous bone marrow mesenchymal stem cells (MSCs) can migrate to the impaired pancreas tissue in the rats with acute necrotizing pancreatitis (ANP). Methods MSCs were isolated from bone marrow of male Sprague-Dawley (SD) rats and adhered to the culture plate in vitro. Female rats were divided randomly into 3 groups:normal transplantation group, ANP transplantation group, ANP group with 10 rats in each group. ANP was induced by intraperitoneal injections with L-arginine. Both transplantation group received MSCs infusion through tail vein. 72 h later, the rats were sacrificed, the pancreas, heart, liver and kidney tissues were harvested, and the morphological changes were examined and scored, the characteristics of migration of MSCs to pancreas were detected with the expression of sry gene of Y chromosome by using chromogenic in situ hybridization (CISH). Results Rapid proliferation occurred in isolated MSCs after culture for 3 ～ 5 days and colonies were formed. After 3 generations, CD29 + CD44 + CD45-cells accounted for over 95% of all the cells. There ware massive tissue necrosis, inflammatory cells infiltration in the pancreas of ANP group, the pathological score was 10.31 ±0. 85, which were significantly higher than that in ANP transplantation group (7.30 ±0.79, P ＜ 0.05). Sry gene could be detected in the pancreas, heart, liver and kidney tissues. In addition, scattered distributed sry positive cells were observed in the normally transplanted pancreatic tissue, lots of sry positive cells were observed in the ANP transplanted pancreatic tissue, and they were located in the most injured areas.Conclusions The inflammatory pancreatic tissue has the ability of recruiting MSCs in vivo, which can alleviate local inflammation.

Objective To observe the effects of hyperbaric oxygen (HBO) on learning and memory ability and on the level of myelin basic protein (MBP) in the brain tissue of rats with delayed neurological sequelae (DNS) after acute carbon monoxide poisoning (COP).Methods Forty-eight male SD rats had their cognitive performance assessed with the Morris water maze.After basic training with the Morris water maze and screening,the rats were randomly divided intoanormalcontrol (NC) group (n=11),a COP group (n=17) and an HBO group (n=17).Pure CO gas was injected intraperitoneally to establish acute COP in the latter two groups.The NC group received a similar injection of air.The HBO group was given HBO therapy.The rats in each group were tested for changes in their learning and memory abilities using the Morris water maze.On the 21 st day after the treatment,paraffin tissue sections of the rats' brains were subjected to immunohistochemical (IHC) examination and Western blotting (WB) was used to detect any expression of MBP in the brain tissue.Results After 21 days,morbidity among the COP group was 64.3％,while it was 26.7％ in the HBO group,a significant difference.The average maze escape latency in the COP group was significantly longer than in the HBO group.IHC staining and Western blotting showed that MBP in the hippocampal tissue of the COP group was significantly lower than that in the HBO group.In gray scale comparisons of the rats' brain tissue,that from the NC group was significantly better than that from the COP and HBO groups,but that from the HBO group was significantly better than that from the COP group.Conclusion HBO can effectively reduce DNS after acute COP,mitigate the severity of DNS,reduce demyelination of brain tissue and thus play an important role in protecting brain cells.

Objective To study the difference in post-resuscitation lung injury between cardiac arrest induced by anoxia and ventricular fibrillation in porcine model.Methods WuZhiShan inbred miniature pigs were randomly (random number) divided into the asphyxia (AS,n =24) and ventricular fibrillation group (VF,n =24).Cardiac arrest (CA) was induced by endotracheal tube clamping or programmed electric stimulation.Cardiopulmonary resuscitation (CPR) or defibrillation was performed for returning of spontaneous circulation (ROSC).Pulmonary perfusion/ventilation measured with isotope scanand positron emission tomography-computed tomography (PET-CT) scanning were done before and 4hrs after ROSC.The oxygenation index (OI),respiratory index (RI),oxygen delivery (DO2),blood lactic acid,and dynamic pulmonary compliance (Cdyn),airway resistance (Raw),extra-vascular lung water index (EVLWI),pulmonary vascular permeability index (PVPI),were measured before cardiac arrest,ROSC 0 h,ROSC15 min,ROSC 30 min,ROSC 1 h,ROSC 2 h,ROSC 4 h and ROSC 6 h.All pigs were sacrificed with euthanasia at ROSC 6 h and the lungs were dissected for observing histopathological changes.The level of Na +-K +-ATPase,Ca2+-ATPase,superoxide dismutase (SOD),Methane Dicarboxylic Aldehyde (MDA),Bcl-2,Bax,Caspase3 and apoptosis index (AI％) in lung were measured.Results The ROSC rate and ROSC 6hrs survival rate of in AS group was lower (P ＜0.01) than those of the VF group.The damages of lung in AS group were more severe than that in VF group by the results of enzymology and protein detection (Na +-K +-ATPase,Ca2 +-ATPase,SOD,MDA,Bax,Bcl-2 and Caspase3).AI％ was higher in AS group (P＜0.01).The deterioration of the indexes (OI,RI,DO2,Lac,Cdyn,Raw,EVLWI,PVPI) at all time points were more severe in AS group than those in VF group.Obvious filling-defect was found by the PET-CT scan of both groups,but not revealed by the isotope scan.Conclusions The lung injury after CA was closely related to the cause of CA rather than the external chest compression.Asphyxia induced more serious lung injury than ventricular fibrillation.

OBJECTIVETo investigate the clinical application of the ureteral dilation catheter combined with the balloon catheter under the ureteroscope in the treatment of urethral stricture in men.

METHODSUnder the ureteroscope, 45 male patients with urethral stricture received placement of a zebra guide wire through the strictured urethra into the bladder and then a ureteral dilation catheter along the guide wire, followed by dilation of the urethra from F8 initially to F14 and F16. Again, the ureteroscope was used to determine the length of the strictured urethra, its distance to the external urethral orifice, and whether it was normally located. An F24 balloon catheter and then a metal urethral calibrator was used for the dilation of the strictured urethra. After removal of the F18-F22 urethral catheter at 8 weeks, the urinary flow rate was measured immediately and again at 3 months.

RESULTSAll the operations were successfully performed without serious complications. The maximum urinary flow rate was (13.3-29.9) ml/s (mean [17.7 ± 3.2] ml/s) at the removal of the catheter and (15.2-30.8) ml/s (mean [19.8 ± 3.9] ml/s) at 3 months after it. Smooth urination was found in all the patients during the 6-24 months follow-up.

CONCLUSIONThe application of the ureteral dilation catheter combined with, the balloon catheter under the ureteroscope is a good option for the treatment of male urethral stricture for its advantages of uncomplicatedness, safety, effectiveness, few complications, less pain, high success rate, and repeatable operation.

Catheterization ; Humans ; Male ; Ureteroscopes ; Urethra ; Urethral Stricture ; therapy ; Urinary Bladder ; Urinary Catheters ; Urination

Objective To observe the angiographic features of patients with retinal vein occlusion (RVO) by ultra-wide-field fluorescein angiography (UWFA) and compare with the conventional 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Fifty-eight eyes of 56 RVO patients were included. There were 25 males (26 eyes) and 31 females (32 eyes). The age ranged from 25 to 69 years, with a mean age of (48.12±18.56) years. The course of disease was from 2 days to 25 months, with a mean course of (12.78±11.35) months. Thirty eyes were diagnosed with central RVO (51.72%), 26 eyes were diagnosed with branch RVO (44.83%) and 2 eyes were diagnosed with hemicentral RVO (3.45%). Retinal laser photocoagulation was performed in 11 eyes (18.97%). All patients received examinations of UWFA (British Optomap 200Tx imaging system) and optical coherence tomography (OCT). Using the protocol for obtaining 7SF images as described in the Early Treatment Diabetic Retinopathy Study, 7 circular regions with a range of 30 degrees were combined as the 7SF template to determine the observation area. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. The visualized retinal area, retinal non-perfusion area, retinal neovascularization area, and laser spot area of UWFA and 7SF were quantified by a retinal specialist. In addition, the OCT images of the affected eye were observed and analyzed to confirm the existence of macular edema. Correlation analysis was done between retinal non-perfusion, retinal neovascularization and macular edema detected by UWFA. Results The results of UWFA and 7SF examination were the same. Compared with 7SF, UWFA showed 3.53 times more retinal visual area, 3.31 times more non-perfusion area, 1.94 times more neovascularization area, and 3.59 times more laser spots (t=72.13, 4.69, 1.76, 5.78;P=0.000, 0.005, 0.102, 0.000). Lesions of 11 eyes (18.97%) were found outside the range of 7SF images. By UWFA, non-perfusion area correlated with neovascularization and macular edema (χ2=12.13, 4.82;P=0.000, 0.028;C=0.42, 0.28). Non-perfusion area anterior to the equator have significantly correlations with macular edema (χ2=6.32, P=0.012, C=0.31), but non-perfusion posterior to the globe equator have no relevance with macular edema (χ2=2.88, P=0.090, C=0.22). Conclusions UWFA can detect more peripheral retinal lesions than 7SF images. By UWFA, non-perfusion area has correlation with neovascularization and macular edema.

Objective To observe the ocular fundus features and consistency of classification of diabetic retinopathy (DR) by ultra-wide-field fluorescein angiography (UWFA) and the simulated early treatment diabetic retinopathy study (ETDRS) 7 standard field (7SF) imaging. Methods This is a retrospective clinical description study. Ninety-six eyes of 55 DR patients were included. The ages ranged from 25 to 73 years, with a mean age of (41.34±15.07) years. UWFA examination (British Optos 200Tx imaging system) using the protocol for obtaining 7SF images as described in the ETDRS, 7 circular regions with a range of 30 degrees are spliced as 7SF templates to determine the observation range. This template was then overlaid on the UWFA image to identify the potential viewable area of 7SF. And the visualized area of the retina, retinal non-perfusion (NP) area, retinal neovascularization (NV) area, and pan-retinal photocoagulation (PRP) area of UWFA and 7SF were quantified by a retinal specialist. Results UWFA imaging and 7SF imaging have a high degree of consistency in judging DR classification (kappa=0.851, P=0.000). The retinal visual area, NP area, NV area and PRP area of the UWFA imaging were 3.16, 3.38, 2.22 and 3.15 times more comparing with the simulated 7SF imaging (t=213.430, 45.013, 22.644, 142.665;P=0.000, 0.000, 0.003, 0.000). The lesions of 8 eyes were found outside the range of simulated 7SF imaging, including peripheral NP in 5 eyes, NV areas in 3 eyes, respectively. Conclusion UWFA imaging and simulated 7SF imaging are consistent to judge DR classification, but UWFA can find more peripheral retinal lesions.

Objective:The purpose of this study was to improve teaching quality of pharmacology by integrating different form of clinical knowledge.Methods:We tried to add the clinical documents such as some related videos and pictures,many common drugs' trade-names and analysis of typical cases into teaching of pharmacology in undergraduate course in our college.Results:Both the theory examination scores and ability of aggregate analysis of cases were higher in the experiment groups than in the controlled ones.And the students considered that the teaching mode with clinical knowledge could stir up their interest in learning pharmacology and increase teaching effect.Conclusion:The teaching mode of incorporating clinical knowledge into pharmacology would be helpful to improve teaching quality of pharmacology.

BACKGROUND: Acute pancreatitis is a serious complication during pregnancy, however the incidence of hyperlipidemia induced by pancreatitis is lower. METHODS: We treated a pregnant woman with hypertriglyceridemia-associated acute gestational pancreatitis who simultaneously developed hypoxemic acute respiratory failure (ARF). RESULTS: The woman was successfully treated through noninvasive positive pressure ventilation (NPPV), emergent caesarean delivery, drainage of chylous ascites, and peritoneal lavage. CONCLUSION: The signs and symptoms of ARF were greatly improved in this patient after NPPV and conventional therapies. Early NPPV may be related to good prognosis of the disease.