Objective To explore the efficacy and safety of conversion from calcineurin inhibitor (CNI) to sirolimus (SRL) as major immunosuppressive therapy in lung transplant recipients.Method Retrospective analyses were conducted for the clinical data of all the patients undergoing lung transplantation in Wuxi People's Hospital between January 2011 and December 2014.Sixteen were given conversion treatment with Sirolimus in the postoperative irnmunosuppressive therapy.We analyzed the opportunity and reasons in the conversion treatment,and the safety,effectiveness and complications of the conversion treatment.Result The follow-up period was 8 to 25 months,and the median time of conversion was 6 months after operation (2-18 months).The indications of conversion concluded:malignant tumor (n =8),renal dysfunction (n =5),lymphangioleiomyomatosis (n =1) and intractable diarrhea caused by CNIs (n =2).Four cases suffered from interstitial pneumonitis associated with Sirolimus and one case suffered from spontaneous pneumothorax,and they all conversed back to CNIs.In those patients,cancer recurrence occurred in 4 cases (of them,there were 3 deaths),and 3 patients developed chronic rejection.Those recipients receiving the conversion treatment due to renal dysfunction showed recovery of renal function to some extent.Conclusion It's effective and safe to converse the immunosuppressive therapy based on Sirolimus.Sirolimus should be reduced or withdrawn when interstitial pneumonitis associated with Sirolimus occurred.

To study the chemical constituents of the fruits of Melia toosendan, three limonoids were isolated and purified by repeated silica gel column chromatography and preparative HPLC from the EtOAc extract of M. toosendan. Their structures were determined by their physico-chemical properties and spectroscopic data (1D-NMR, 2D-NMR) as: 24, 25, 26, 27-tetranorapotirucalla-(apoeupha)-1alpha-tigloyloxy-3alpha, 7alpha-dihydroxyl-12alpha-acetoxyl-14, 20, 22-trien-21, 23-epoxy-6, 28-epoxy (1), nimbolinin B (2), and trichilinin D (3), separately. Compound 1 is a new compound, and compound 2 is obtained from this plant for the first time.

OBJECTIVE: To explore the proliferation inhibition and apoptosis of polysaccharides extracts from polysaccharides extracts from Hedyotic diffusa (PEHD) on Human Nasopharyngeal Carcinoma (NPC)cell line CNE2 cells in vitro. METHOD: CNE2 cells treated with various concentrations of PEHD were detected by MTT assay at 24 h, 48 h, and 72 h. The apoptotic cells were analyzed by flow cytometry with Annexin V/PI staining. The expression levels of Bax, Bcl-2 and caspase-3 protein were examined by Western blotting method. RESULT: The growth of CNE2 cells were suppressed after treatment with PEHD (P < 0.05), MTT assay showed that the highest cell inhibition rate reached to 76.5%, the inhibition in the doses from 2 to 6 mg/ml showed dose-and-time-dependent. The percent of apoptosis in 4 and 6 mg/ml PEHD treatment groups for 48 h were 31.32%, 46.28%, respectively, and significantly higher than that in control groups, 4.86% (P < 0.01). After the cells being treated with PEHD for 48 h, the expression of Bax and caspase-3 protein increased, and the expression of Bcl-2 protein decreased gradually. CONCLUSION PEHD could inhibited the growth of CNE2 cells and was dose-and-time-dependent, the mechanism may involve induction of cell apoptosis, which was associated with the activation of Bax and caspase-3 protein and the down-regulation of Bcl-2 protein expression.
Apoptosis ; Carcinoma ; Caspase 3 ; metabolism ; Cell Line, Tumor ; drug effects ; Cell Proliferation ; Down-Regulation ; Hedyotis ; chemistry ; Humans ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; pathology ; Plant Extracts ; pharmacology ; Polysaccharides ; pharmacology ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; bcl-2-Associated X Protein ; metabolism

Objective To analyze the diagnosis and treatment of airway stenosis in a consecutive series of bronchial anastomosis after lung transplantation in our center.Methods We performed a retrospective study on 100 cases of lung transplants in our center from September 2002 to December 2010.Seventy-two cases were subjected to single lung transplants (SLT), and twenty-eight to bilateral sequential single lung transplantation (BSSLT). There were totally 128 bronchial anastomoses.All recipients received long-term follow-up to monitor the lung function.Lung CT and fibrobronchoscopic examinations were done when necessary. Results Twenty-five cases with 37 bronchial anatomoses were died.A total of 12 airway stenosis occurred in 10 cases (12/128,9.4 ％).Four cases underwent telescopic anastomosis and 6 cases underwent end-to-end anastamosis.Mean diagnosis time was 60.1 35.6 days post-operation (ranging from 15-120 days,median 59 days).There were 8 cases of unilateral airway stenosis (3 on the left,and 5 on the right) and 2 cases of bilateral airway stenosis.The number of simple airway stenosis was 3,that of exophytie granulation tissue was 8,and that of bronchus intermedius stenosis was 1.Culture of bacteria by fibrobronchoscopy with protected specimen brush revealed:3 strains of Pseudomonas aeruginosa,2 strains of Klebsiella pneumoniae,2 strains of Aspergillus,1 strain of Escherichia Coli. 10 cases were treated with fiberoptic bronchoscopic balloon dilation:5 cases with high-frequency electrotome,4 cases with stent placement,and 1 case with argon plasma coagulation (APC).Seven cases were cured or improved and 3 cases died.Conclusion Airway stenosis after lung transplantation remains a major problem.The fiberoptic bronchoscopic procedure is the gold standard to diagnose. The preferred treatment is fiberoptic bronchoscopic balloon under expansion,and other approaches include high-frequency electrotome,APC and stem placement,etc.

Objective To observe the therapeutic effects of lung transplantation for diffuse pulmonary disease. Methods From September 2002 to April 2009, lung transplantation was performed on 72 cases in our hospital. Thirty-seven cases of these recipients were suffered from diffuse pulmonary disease, including idiopathic pulmonary fibrosis (30/37), pneumosilicosis (4/37), vascular leiomyoma (2/37) ,diffuse panbronchiolitis (1/37),30 males and 7 females with age ranging from 22 to 73 years old (mean 52.9 ± 13.2). All the patients received pulmonary function test and echocardiography (ECHO) to test the pulmonary artery systolic pressure before transplantation and artery blood gas to calculate the oxygenation index (PaO2/FiO2 ). Results The systolic pulmonary artery pressure (Ppa,syst) was monitored by Swan-Gans catheterization one week post-transplant, and decreased significantly from 54. 30 ± 17. 41 to 41.52 ± 9. 36 mm Hg (P＜0. 05). Simultaneously, oxygenation index was improved from 185. 89 ± 77. 25 to 392. 12 ± 98. 23 (P＜0. 05). The pulmonary function was also improved significanzly one month post-operation. The volume in the first second was improved from (1.33 ± 0. 64) to (1.81 ± 0. 57) L, and the diffusion capacity of carbonmonoxide was increased from (2. 87 ± 1.26) to (4. 22 ± 2. 05) L. Conclusion Lung transplantation is feasible and efficient to deal with diffuse pulmonary disease.

Objective To explore the protective effect of Salvianolic acid B on isolated lung in rats.Method Twenty-four SD rats were randomly divided into 2 groups:control group and experimental group (n =12 each).The isolated lung in control group was perfused with raffinose-low potassium dextran (R-LPD),and that in experimental group was perfused with R-LPD and 800 mg/L of Salvianolic acid B.The model of isolated lung was established in all these rats.Wet/dry weight ratio (W/D),myeloperoxidase (MPO),malondialdehyde (MDA) and superoxide dismutase (SOD) were measured,and the pulmonary structures were observed by HE staining at different preservative periods of 6,9,12 and 24 h after infusion.Result Intragroup comparison was made in both groups:all parameters had no statistically significant difference before 12 h.However,W/D,MPO,MDA,and SOD at 24 h were higher than those at 12 h (P＜0.01).The result of interclass comparison showed that after 6,9 and 12 h preservation,all parameters of these two groups showed no significant difference.However,W/D,MDA and MPO were lower,and SOD was higher after 24 h preservation in control group (P＜0.05).Moreover,before 12 h preservation,the two groups did not show inflammatory injury,only manifested slight inflammatory reaction histologically.Destructive pulmonary structure,alveolar interstitial edema and inflammatory damage were seen more clearly in control group than in experimental group.Conclusion The perfusion with Salvianolic acid B had no apparent superiority before 12 h.However,after 12 h,it could ensure the quality and prolong the preservation time of the donor lungs more effectively.Salvianolic acid B might play an important role in donor lungs protection.

Objective To analyze the distribution and drug resistance of pathogens for bacterial infection after lung transplantation,so as to provide evidence for clinical prophylactic strategies postoperation and reasonable use of antibiotics.Method The bacterial distribution and drug resistance of 81 recipients after lung transplantation in our hospital were retrospectively analyzed from May 2009 to October 2012.The VITEK-32 full-automatic microbial identification system (Biomerieux,France)and its supplementary reagent were used for bacterial identification and drug sensitive test.The data were statistically analyzed by using the software SPSS 13.0.Result There were 67 cases of bacterial infection in the 81 recipients after lung transplantation and the infection rate was 82.72％ (67/81).The infection was caused by one kind of bacteria in 20 patients,two kinds of bacteria in 23 patients and multiple bacteria in 24 patients.157 strains pathogenic bacteria were produced,and the grampositive bacilli and the gram-negative bacilli accounted for 12.74％ and 87.26％ respectively.The most common pathogens for the bacterial infection were Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa,Stenotrophomonasmaltophilia,Escherichia coli and Staphylococcus aureus.Most of the bacterial infections occurred in the early period (≤1 month) after lung transplantation and most non-fermentative bacterial pathogens were resistant to multi-antibiotics.Conclusion The bacterial infection rate is high after lung transplantation.The rational use of antibiotics in clinical practice should be adjusted according to the bacterial distribution and drug resistance.

Objective To investigate the institution of extracorporeal membrane oxygenation (ECMO) for primary graft dysfunction (PGD) after lung transplantation (LT) and analyze its clinical outcome.Method A retrospective analysis was performed on 22 patients with grade 3 PGD in early stage after LT from September 2002 to December 2013.There were 7 patients with single LT and 15 patients with bilateral LTx.Ventilatory support was used at early stage for 6 cases,and at later stage,ECMO assistant circulation was used for 16 cases.Result Of 6 patients treated by adjusting low volume,high frequency and high positive end expiratory pressure ventilation (PEEP) mode,2 cases reversed,and 4 cases died of respiratory failure.In 16 cases accepting ECMO support,10 cases were given venous-venous mode and 6 cases venous-artery mode.The average flow time was 5.5 days.ECMO was successfully withdrawn in 10 cases and 6 cases died of multiple organ failure,infection and cardiac arrest.Conclusion The high incidence of PGD causes high mortality peri-operatively after LT.Preventing ECMO can improve the survival rate of the lung transplant patients.Once PGD happens,appropriate treatment should be given as soon as possible.ECMO can effectively promote the transplanted lung function recovery,and reduce the perioperative mortality.If the indications of ECMO use was reached,the institution of ECMO should be used as soon as possible.

ObjectiveTo evaluate the prevention and treatment of primary graft dysfunction (PGD) after lung transplantation (LTx).MethodsWe retrospectively analyzed clinical data of108 cases of lung transplantation from September 2002 to June 2011. All the recipients were given continuous monitoring of invasive arterial pressure,pulmonary artery pressure and (or) central venous pressure and artery blood gas analysis and chest X-ray examination postoperatively.The negative fluid balance of the recipients in the first 3 days was maintained.The inspired oxygen (FiO2) or ventilator parameters was adjusted according to the arterial oxygen tension (PaO2) and (or) oxygen saturation,to prevent the occurrence of PGD.Once PaO2/FiO2 sharp decline (less than 200),and chest X-ray showed higher density of the lower transplanted lung fields in the early postoperative period,PGD could be diagnosed when acute rejection,venous anastomotic obstruction,cardiogenic pulmonary edema and pulmonary infections were excluded.According to the standards set by the International Association of Heart and Lung Transplantation,PGD is divided as 0,1,2 and 3.Different levels of PGD were treated by ventilatory support,negative fluid balance,extending the treatment time of the ventilator,the use of pulmonary vasodilators,such as prostaglandin E1and the use of ECMO.Results PGD occurred in10 cases,and the incidence rate was 9.3％. 6 cases were given conventional ventilatory support for (285.8 + 238.6) h (Two cases obtained reversal of PGD,and four cases died) ; the rest four cases were given ECMO (Two cases were supported by ECMO in 24 h after the occurrence of PGD and had a long-term survival after a successful reversal of PGD,and the rest two cases died from acute renal failure and multiple organ failure induced by PGD on the 8th and11th day of the application of ECMO due to the late application of ECMO (after 24 h).ConclusionThe high incidence of PGD causes high mortality perioperatively after lung transplantation.Preventing PGD can improve the survival rate of the lung transplant patients.Once PGD happens,appropriate treatment should be given as soon as possible.

Objective This study aimed to define research status of age -related hearing loss ,and provide the basis and direction for future research .Methods We have retrieved all relevant literatures on age -related hearing loss from Pubmed ,and conduct an objective analysis of the existing literatures by Bibliometric analytics and co -word analysis method using co -occurrence bibliographic information mining system and SPSS22 .0 software for data analysis .Results There were a large number of articles and journals about presbycusis and age -related hearing loss .Many countries were involved in the research .Literatures and core authors were mainly from developed coun‐tries such as Europe and the United States .The quantity and quality of Chinese literatures were in a leading position in Asia .The researches focused on the common characteristics of patients ,the epidemiology ,characteristics of hear‐ing ,treatment and laboratory studies .There were some new research directions in recent 5 years ,such as factors as‐sociated with the younger ages before developing presbycusis ,standard design and use of questionnaires ,prevention and control .Conclusion Age-related hearing loss will continue to be a hot topic with growing focus on micro and macro development of multi -disciplinary cooperation .The penetration will be the trend for the future research while the prevention will become a new focus of research .