In recent years, although the quantity of organ donation after citizen's death has been constantly increased, a large number of patients with end-stage renal diseases are waiting for kidney transplantation every year. The imbalance between donor and recipient is still one of the main problems affecting kidney transplantation in clinical practice. Therefore, it is of clinical significance to accurately evaluate the quality of donor kidney and fully utilize the expanded criteria donor kidney. Contrast-enhanced ultrasound has been gradually applied in the detection of multiple solid organs due to its safety, portability, real-time detection, quantification and other characteristics, and it also has promising application prospect in the evaluation of donor kidney quality. In this article, the advantages and limitations of current evaluation methods for donor kidney and current status and advantages of contrast-enhanced ultrasound in donor kidney evaluation were reviewed, and the application prospect of contrast-enhanced ultrasound in the evaluation of donor kidney quality was discussed, aiming to increase the methods and enhance the accuracy for donor kidney evaluation, and provide reference for rational use of expanded criteria donor kidney.

Objective: To explore age-related clinical characteristics, early responses and outcomes in non-senile adults with de novo acute myeloid leukemia (AML). Methods: Data of consecutive cases of 18-65 years adults with de novo AML (non-acute promyelocytic leukemia) were reviewed retrospectively. Clinical characteristics at diagnosis, early responses and outcomes across different age groups of patients were analyzed. Results: 1 097 patients were enrolled. 591 (53.9%) were male. Median age was 42 years. Increasing age was significantly associated with decreasing WBC count (P=0.003), increasing PLT count (P=0.034), lower blast proportions in bone marrow (P=0.021). The incidence of NPM1⁺/FLT3-ITD^- increased with age (P<0.001). Multivariate analyses showed that increasing age was associated with low probabilities of achieving morphologic leukemia free state (MLFS) (P=0.053) and complete remission (CR) (P=0.004) and poor overall survival (OS) (P=0.070) in the whole patients population. However, increasing age was not associated with low MLFS rate and poor OS, except low CR rate (P=0.075) in those receiving standard induction regimen instead of low-intensity regimen. Conclusions There were significant differences on clinical characteristics, cytogenetics and molecular genetics across different age groups in non-senile adults with de novo AML. In the patients receiving standard induction regimen, age was not associated with MLFS rate and OS.

Objective To evaluate the value of IVIM-DWI and DTI parameters in quantitative analysis and differential diagnosis of invasive breast carcinoma of no special type(NST).Methods We retrospectively analyzed 60 patients (63 lesions)who underwent MR examination in our hospital and all lesions were verified by pathologic results.MR protocol included DCE-MRI,IVIM-DWI using 14b values and DTI.The ADC,ADCslow,ADCfast,f,λ1of lesions were measured and compared by two independent samples t test between the benign lesions and NST.Logistic regression analysis was made using ADC,ADCslow,f,λ1as predictors in detecting and differentiating the NST,ROC analysis was performed to compare diagnostic performance based on the area under the curve(AUC).Results The ADC,ADCslow,ADCfast,f andλ1of NST were (1.49±0.63)×10-3mm2/s,(1.32±0.49)×10-3mm2/s,(25.98±21.84)×10-3mm2/s,0.20±0.13 and (4.98±0.47)×10-3mm2/s,these values of benign lesions were (2.31±0.66)×10-3mm2/s,(2.24±0.65)×10-3mm2/s,(18.71± 12.26)×10-3mm2/s,0.33±0.15 and(5.59±0.59)×10-3mm2/s.All parameters except ADCfast(P=0.271)had significantly statistical differences (P<0.000 1)between NST and benign lesions.The regression model showed that ADCslowwas an independent predictor in NST’s detection.Conclusion The ADC,ADCslow,f andλ1is helpful for differentiation between NST and benign lesions.The regression model is most valuable in NST detection and ADCslowis the preferred index.

Objective To estimate the value of diffusion tensor imaging (DTI) in early diagnosis of chronic allograft nephropathy (CAN) and monitoring of graft fibrosis in rat models . Methods Thirty CAN rat models were established as experimental group by transplanting Fisher donor kidneys into Lewis recipients. Thirty Lewis rats that received Lewis kidneys served as control group. Serum creatinine (SCr) was monitored regularly every two weeks from 14 days after transplantation. Eight rats were randomly selected by random number table method and underwent DTI examination at 4, 12, 20 weeks after modeling. DTI scans were performed on the renal cortex and medulla to measure apparent diffusion coefficient (ADC) and fractional anisotropy (FA). From the remaining 22 rats in each group, 6 rats were randomly selected and underwent pathological analysis at 4, 12, 20 weeks after modeling. Histological changes in the kidney were evaluated by chronic allograft damage index (CADI) scores. The expression of alpha-smooth muscle actin (α-SMA) and Vimentin were quantitatively measured. The differences in creatinine, DTI parameters, CADI score, α-SMA, Vimentin expression level were analyzed by two independent samples t test in two groups, the differences among CADI score, α-SMA, Vimentin expression level of the experimental group were compared using ANOVA. The correlations among DTI parameters and CADI score, α-SMA and Vimentin expression level were analyzed using Pearson analysis. Results The creatinine in the experimental group increased continuously, and the creatinine in the control group showed no significant increase. The difference in creatinine between the two groups was statistically significant from 8th week after operation (P＜0.01). There was no obvious difference in the size and signal intensity of transplanted kidneys in control group at different time points. Compared with the control group, the graft kidney in the experimental group at the 4 weeks demonstrated increased signal intensity with mild increased volume of kidney, and the boundaries between cortex and medulla were not clear. The cortex and medulla showed gradually increased signal intensity, heterogeneous signal distribution and marginal haziness over time. The ADC and FA value of renal cortex and medulla in experimental group were significantly lower than those in control group at 4, 12, 20 weeks (P＜0.05). The ADC and FA values of the cortex and medulla gradually decreased in the experimental group over time, while the values of the parameters in the control group did not show a significant decrease. The ADC and FA values of the cortex and medulla were negatively correlated with the scores of CADI, and the expression level of α-SMA, Vimentin in the experimental group(r=－0.50 to －0.85, P＜0.01).Conclusion DTI can be an effective technique for early diagnosis of CAN and monitoring of graft fibrosis process.

Objective To evaluate the clinical efficacy and complications of lattice carbon dioxide laser in the treatment of female mild to moderate stress incontinence.Methods 30 cases of mild to moderate stress urinary incontinence in our hospital from August to October 2017 were reviewed.The average age was (46.5 ±3.5) years old,all married and has been bred,12 patients with mild stress incontinence and 18 patients with moderate stress urinary incontinence.Preoperative preparation including:1h urine cushion test measured leakage of urine,urine flow rate,residual urine,the international consultation on incontinence questionnaire (ICI-Q-SF) score,urine routine examination.Preoperative urine flow rate (31.87 ± 2.42) ml/s,preoperative (1 h) pad test (8.19 ± 2.42) ml,preoperative ICI-Q-SF score (4-8).The power was 12.5 mJ,the efficacy was 25％,and the single treatment was chosen.Urine flow rate,1 h urine pad test,residual urine test,ICI-Q-SF score,and subjective satisfaction were recorded at 1,3,6 months after operation.Results All 30 patients in this group were followed up for more than 6 months.The pad test was (2.14 ± 0.36) ml,(1.02 ± 0.54) ml,(0.80 ± 0.41) ml at 1,3 and 6 months postoperatively,which were significantly different from preoperative pad test (P ＜ 0.01,).The urine flow rate at 1,3,6 months after operation was (30.53 ± 3.15) ml/s,(32.19 ± 2.72) ml/s,(31.23 ± 5.76) ml/s,respectively,and there was no significant difference between the 3 groups (P ＞ 0.05).There was no significant difference between preoperative and postoperative urine flow rate (P ＞ 0.05).The ICI-Q-SF at 1,3,6 months after operation were 3 (1-4),3 (0-4),3 (0-4),which were significantly different from preoperative ICI-Q-SF.Among the 30 patients,3 cases had frequent urination after operation,1 case had frequent urination before operation,and became more severe after operation.The residual urine of 30 patients was negative after operation.All patients had no dysuria and no vaginal bleeding.No signs of urinary incontinence were observed after 6 months follow-up.Conclusions For patients with mild stress urinary incontinence,there is no obvious serious complication in the short term after the laser treatment of dot matrix carbon dioxide laser.The clinical treatment is safe and the leakage of urine can be improved.

Objective: To analyze the clinical value of real-time PCR for virus detection in the diagnosis and treatment of patients after allo-HSCT who had no infection evidence of pneumonia using routine pathogen detection panel. Methods: The clinical data of 71 episodes with acute lung injury from May 2015 to March 2017 after allo-HSCT in hematology department of Peking University People’s Hospital (PKUPH) were retrospectively analyzed. PCR for virus detection and other routine pathogen detection tests were performed on bronchoalveolar lavage fluid (BALF) samples. Results: Among 71 episodes with acute lung injury, a total of 15 patients were diagnosed as lower respiratory tract disease merely associated with virus (detection rate of 21.13%) , 19 episodes were absent of lower respiratory tract infection. The median time from allo-HSCT to the occurrence of lung injury were 176 (49-1 376) d and 196 (57-457) d respectively (z=-0.191, P=0.864) . There were no statistical differences for baseline characteristics and clinical features between two groups. The 100-day attributable mortalities were 13.3% (2/15) and 26.3% (5/19) (χ²=0.864, P=0.426) . Patients with low-dose steroids treatment had favorable outcome than those with high-dose steroids treatment (the dose of methylprednisolone ≥250 mg/d as standard) [4.2% (1/24) vs 60.0% (6/10) ]. In patients with detectable virus in BALF, 2 patients died with early high-dose steroids treatment, while 11 patients survived with no steroids treatment or late application. Conclusions Virus infection should be considered in post-HSCT pneumonia patient with negative result using routine pathogen detection panel. Expanding virus detection panel by PCR in BALF could increase diagnostic precision and might be instructive to treatment.

Objective Budd-Chiari syndrome is apt to be misdiagnosed,so we explore its diagnosis and treatment by liver transplantation.Methods We retrospectively analyzed the clinical data of two patients who underwent liver transplantation for Budd-Chiari syndrome.One patient was misdiagnosed before the transplantation and another was diagnosed correctly.Results Both patients were grouped to Child C category with decompensated liver cirrhosis.Patient 1 was diagnosed as recurrent hepatocellular carcinoma,but the etiology of liver disease was first unknown then suspected to be schistosomiasis.This patient underwent piggyback liver transplantation.Because there was significant swelling in the perineum and lower extremities after liver transplantation,we re-reviewed the preoperative imaging data and found communicant veins between hepatic veins,which proved that the patient was actually suffered from Budd-Chiari syndrome with hepatic vein and suprahepatic vena cava occlusion before the transplantation.After conservative treatment,the swelling of the lower body was alleviated,however,the long-term survival of the patient would be compromised.Learning from the first case,we found communicant veins between hepatic veins in imaging data of patient 2,resulting in correct diagnosis of Budd-Chiari syndrome with hepatic vein and retrohepatic vena cava diseases before the transplantation,so the patient underwent orthotopic liver transplantation,in which the liver and retrohepatic vena cava were resected,and recovered uneventfully.Liver function was normal during the follow up period of 7 months.Conclusion We should consider the possibility of Budd-Chiari syndrome in patients with unexplained end-stage liver diseases.Communicant veins between the hepatic veins shown in thin CT or MRI image are the characteristic sign for diagnosing Budd-Chiari syndrome.Simultaneously hepatic vein or cava vena disease determines the choice of various technique of liver transplantation.

Objective To investigate the effect of tripterygium glycosides on the resistance to immune rejection after allogeneic islet transplantation in mice.Methods Twenty C57BL/6 mice were treated with STZ diabetes mellitus and transplanted the islets from Balb/c mice donor,then recipient mice were randomly divided into two groups:triptolide group and model control group(n=10),and were intraperitoneal injected with tripterygium glycoside solutin and equivalent solvent of 5 mg·kg-1·d-1 for 14 days.Blood glucose and body weight were measured within 4 weeks after transplantation.Two weeks later,two groups of grafted islets were stained by HE staining and immunohistochemical staining,the expression of IL-2 protein were detected by Western blotting.Results The level of blood glucose were decreased to normal in the triptolide group and model control group after islet transplantation,but blood glucose gradually increased in the model control group after two weeks.Compared with the model control group,the inflammatory cells were less infiltrated and the immunohistochemical staining of insulin was deeper in the triptolide group.The expression of IL-2 in the triptolide group was significantly decreased(P<0.05).Conclusion Tripterygium glucoside could significantly decrease the inflammatory cell infiltration and inflammation factor expression in the allogeneic islet recipients to reduce the immune rejection and improve graft survival.

Objective To observe the effects of electroacupuncture at Ganshu (BL18) and Zusanli (ST36) on depression state and gastrointestinal motility and relevant protein expressions in brain of rats with stress-induced depressive functional dyspepsia. Methods Totally 48 Wistar rats were randomly divided into normal, model, electroacupuncture (EA) and sham-operation group, with 12 rats in each group. Depressive functional dyspepsia model was established by chronic unpredictable mild stress protocols. From day 15 to day 28, the EA group was given electroacupuncture at BL18 and ST36, and the sham-operation group was stimulated by electroacupuncture at 1/3 and 2/3 of the tail. Body weight test, open field test and sucrose preference test were measured on day 0, day 14 and day 28. After 14-day administration, gastric residual volume and intestinal propulsion rate of semisolid paste were detected. The expression of βCaMK inⅡ lateral habenulas and BDNF in hippocampus were measured by Western blot. Results Compared with the normal group, the weight, the sucrose preference rate, the behavior score, the small intestinal propulsion rate of semisolid paste and the expression of BDNF in hippocampus decreased significantly both in the model group and sham-operation group (P<0.01), and the gastric residual volume of semisolid paste and the expression of βCaMK inⅡ lateral habenulas increased significantly (P<0.01). Compared with the model group, the weight, the sucrose preference rate, the behavior score, the small intestinal propulsion rate of semisolid paste and the expression of BDNF in hippocampus increased significantly in EA group (P<0.01), and the gastric residual volume of semisolid paste and the expression of βCaMK inⅡ lateral habenulas decreased significantly (P<0.01). Compared with the sham-operation group, the expression of βCaMKⅡ in lateral habenulas decreased significantly, the expression of BDNF in hippocampus increased significantly in EA group (P<0.01). Conclusion Electroacupuncture at Ganshu (BL18) and Zusanli (ST36) can improve depression and gastrointestinal motility of rats with depressive functional dyspepsia, which may be related to the inhibition of βCaMK inⅡ lateral habenulas and the activation of BDNF in hippocampus dyspepsia.

OBJECTIVETo compare the outcomes of patients with adult acute lymphoblastic leukemia (ALL) over the last 14 years by taking 2006 as the demarcation point.

METHODSFrom January 2000 to December 2013, 477 consecutive hospitalized patients with adult ALL were retrospectively analyzed, including 276 (57.9%) with Ph negative B-ALL (Ph⁻-B-ALL) B-ALL, 69 (14.5%) with T-ALL and 132 (27.7%) with Ph positive ALL (Ph⁺-ALL); 111 (23.3%) before 2006 and 366 (76.7%) after 2006. Among 435 patients who achieved complete remission (CR), 248 (57.0%) received allogeneic hematopoietic stem cell transplantation (allo-HSCT), and 187 remained on chemotherapy.

RESULTSWith a median follow-up period of 19 months in all patients and 35 months in living patients, overall CR rate was 92.0%. Of 435 CR patients, the cumulative incidences of 5-year relapse, disease-free survival( DFS) and overall survival (OS) rates were 42.5%, 46.2% and 47.6%, respectively. Compared with the patients hospitalized before 2006: ① the Ph+-ALL patients hospitalized after 2006 achieved a higher overall CR rate (P=0.036). There was no difference for CR rates of Ph--B-ALL and T-ALL patients between before and after 2006. ②The CR patients hospitalized after 2006 had higher 5-year DFS and OS rates (P=0.001; P < 0.001), including higher 5-year OS rate in Ph⁻-B-ALL patients (P=0.046), and higher 5-year DFS and OS rates in both T-ALL (P=0.013; P=0.036) and Ph⁺-ALL patients (P=0.003; P < 0.001) , especially in those Ph⁺-ALL patients who received imatinib from the beginning of the induction chemotherapy (P < 0.001; P < 0.001) ③The patients who received allo-HSCT after 2006 had higher 5-year DFS and OS rates (P=0.001; P < 0.001), but there was no difference for the outcomes in those who remained on chemotherapy before and after 2006. After 2006, Ph⁺-ALL patients who received imatinib from the beginning of the induction chemotherapy had the highest 5-year DFS and OS rates compared with Ph⁻-B-ALL and T-ALL patients (P=0.009; P=0.001) . Multivariate analysis showed that allo-HSCT and imatinib were two important factors affecting the outcomes of ALL patients.

CONCLUSIONThe outcomes of ALL patients improved significantly over the last 14 years, especially in Ph⁺-ALL ones.

Acute Disease ; Adult ; Disease-Free Survival ; Hematopoietic Stem Cell Transplantation ; Humans ; Imatinib Mesylate ; therapeutic use ; Induction Chemotherapy ; Multivariate Analysis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; therapy ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma ; therapy ; Recurrence ; Remission Induction ; Retrospective Studies ; Survival Rate