Background Vascular endothelial growth factor(VEGF) has been shown to be associated with the pathogenesis of age-related macular degeneration (AMD),therefore VEGF is a target for the treatment of wet AMD.However,the mechanism of VEGF in the pathogenesis of AMD is not clearly understood.Studying the correlation between VEGF gene polymorphism and AMD is becoming a new research hotspot,but relevant studies on Han Chinese have not been performed.Objective This study was to investigate the association between the VEGF +936C/T gene polymorphism and AMD in the Chinese population.Methods A pilot prospective and nonrandomized controlled trial was designed.This protocol complied with Declaration of Helsinki and was approved by the Ethic Committee of Chinese PLA Second Artillery General Hospital.Written informed consent was obtained from each subject prior to entering the study.Two hundred AMD patients and 200 age-and gender-matched normal controls were enrolled in this study.The genomic DNA was extracted from the peripheral blood samples of the subjects,and analysis of the VEGF polymorphisms at the +936 position in the promoter and 3＇-untranslated regions was performed by the restriction fragment length polymorphism method.Frequencies of the VEGF+936C/T genotype were compared between the two groups,and the risk of the VEGF+936C/T gene polymorphism in pre-disposing AMD was evaluated.Results No significant differences were seen in the incidence rates of smoking(P ＝ 0.76),hypertension(P ＝ 0.84),hyperlipidemia (P=0.71),diabetes mellitus (P=0.86) and cardiovascular disease(P=0.89) between the AMD group and the normal control group,and BMI was matched between the two groups (P =0.18).The prevalence of the TT genotype was 9.0％ (18/200)in the AMD group,but that in the normal control was 3.5％ (7/200),showing a significant difference between the two groups (P =0.03).The odds ratio (OR) was 2.73 with a 95％ confidence interval(CI) of 1.11 to 6.68 for AMD in this genotype.The CC and CT genotypes were not significantly different between the two groups (P =0.52,P =0.57).The genotype frequency and allele frequency conformed to HardyWeinberg equilibrium law.There were no significant differences found in the CC,CT,TT genotype frequencies among the early AMD,geographic atrophy AMD and choroidal neovascular AMD (all at P＞0.05).Conclusions The VEGF+936TT genotype is associated with AMD in Han Chinese population.

Objective: To give the living-donor and recipient medical evaluation and moral evaluation pretransplant by Academic and Ethics Committee for Organ Transplantation (AECOT), ensure the transplantation proceed smoothly and the feasibility for moral principles. Methods:AECOT was formed and gave the living-donor and recipient medical evaluation, additional moral evaluation to their family, evaluated the possibility for transplantation, ensured the long-dated safety for living-donor and recognition for ethics, ensured the transplantation proceed successfully. Results: 18 cases were evaluated by AECOT, two cases had the operation refused because of the II-diabetes for one living-donor and the other living-donor refused evaluation, one case had the operation delaied because of the overweight for the living-donor. The rest 15 cases were accepted operation smoothly,both donor and recipient recovered well post transplant. Conclusion:Academic and Ethics Committee for Organ Transplantation(AECOT) is a essential agency for Living Donor Kidney Transplantation.

Objective To explore the value of readout segmentation of long variable echo-trains (RESOLVE) in the differentiation of prostate cancer from benign prostatic hyperplasia (BPH).Methods Seventy two consecutive patients with suspected prostate cancer were evaluated by 3.0 T MR examination (RESOLVE sequence included,b values=0 and 800 s/mm2) were included in our retrospective study.All the patients had ultrasound guided systemic biopsy with histopathological diagnosis.The patients were divided into group A (23 prostate cancer cases with total 43 malignant lesions) and group B (49 BPH cases with total 64 benign lesions).Two radiologists who were blinded to the clinical data quantitatively analyzed the ADC values of suspicious lesions independently.Inter-reader agreement for ADC values was assessed with Bland and Altman test,and the intra-class correlation coefficient (ICC).Difference of ADC values in two groups was assessed by student's t test.Receiver operating characteristic curve (ROC) was used to determine the best predictor and cutoff value.Results A total of 107 lesions (43 malignant and 64 benign) were identified in 72 patients.ICC was 0.976,P＜0.01.The mean ADC value of prostate cancer is lower than BPH (t=19.223,P＜0.01),(0.74±0.12) × 10 3 and (1.21±0.12) × 10-3mm2/s respectively.Diagnostic cut-off point was 0.946× 10-3mm2/s,diagnostic sensitivity 95.3 ％ (41/43),specificity 98.4％ (63/64),accuracy 97.2％ (104/107).Conclusion RESOLVE ADC value is valuable in the differential diagnosis of prostate cancer and BPH.

OBJECTIVETo explore the effect of total flavonoids of Herba Epimedium (FHE) on BMP-2/RunX2/OSX signaling pathway in promoting osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs).

METHODSPassage 3 BMSCs were randomly divided into the control group, the experimental group, and the inhibitor group. BMSCs in the control group were cultured in 0.2% dimethyl sulfoxide + Osteogenuxic Supplement (OS) fluid + DMEM/F12 culture media. BMSCs in the experimental group were intervened by 20 microg/mL FHE. BMSCs in the inhibitor group were intervened by 20 microg/mL FHE and 1 microg/mL NOGGIN recombinant protein. At day 9 alkaline phosphatase (ALP) activity was measured. Calcium nodules were stained by alizarin red staining and the density was observed. The transcription expression of osteogenic differentiation-related proteins (type I collagen, osteocalcin, and osteopontin) and related factors of BMP-2/RunX2/OSX signaling pathway was assayed by RT-PCR.

RESULTSCompared with the control group, ALP activities were enhanced and the density of calcium nodules significantly increased; type I collagen, osteocalcin, and osteopontin expression levels were increased in the experimental group. The expression of osteogenesis-related transcription factor was also increased in the experimental group. Noggin recombinant protein inhibited FHE promoting BMSCs osteogenesis in the inhibitor group. Compared with the experimental group, ALP activity decreased (P < 0.05), the density of calcium nodules was lowered, expression levels of type I collagen, osteocalcin, osteopontin significantly decreased (P < 0.05) in the inhibitor group.

CONCLUSION20 microg/mL FHE promoted osteogenic differentiation process of BMSCs by BMP-2/RunX2/OSX signaling pathway.

Bone Morphogenetic Protein 2 ; metabolism ; Cell Differentiation ; drug effects ; Cells, Cultured ; Collagen Type I ; metabolism ; Core Binding Factor Alpha 1 Subunit ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Epimedium ; chemistry ; Flavonoids ; pharmacology ; Humans ; Mesenchymal Stromal Cells ; cytology ; drug effects ; Osteocalcin ; metabolism ; Osteogenesis ; drug effects ; Osteopontin ; metabolism ; Signal Transduction ; Sp7 Transcription Factor ; Transcription Factors ; metabolism

In this paper, vegetative( vip83 ) and crystal(cry1Ac10 and cry1Ca) insecticidal protein genes from Bacillus thuri ngiensis were simultaneously electrospored into the plasmid-free strain BMB17 1. By the means of the specific P CR detection, the recombinant strains BMB2830-171 contained cry 1Ac10 and vip83, and BMB2 882-171 had cry1Ca and vip83 , were obtained respectively. Under the control of r ecombinant strains with one gene, bioassay of the synergism between vegetative V ip83 and crystal Cry1Ac10( or Cry1Ca )insecticidal proteins to three important Lepidopteran pests were done. The results, by analysis of statistic bio-so ft, showed that the synergia relation of vegetative Vip83 and crystal Cry1Ac10 i nsecticidal protein toxic to Heliothis armigera wascounteracted, while Plu tella xylostella and Spodotera exigua unobservable. There was no synergis tic action between Vip83 and Cry1Ca insecticidal proteins with Spodotera exigu a as tested insect. Bu t their cooperation to Heliothis armigera was minus, and the counterpart to Plutella xylostella plus, whose cotoxicity factor is 32.6. The experiment of bi-g ene genetic stability also suggested that the synergia effection had certain molecu lar genetic stability in the same cell. This performance can be contributed to construct high-effect and wide-spectrum engineered strain.

Objective To observe the effects of early intravenous administration of Astragalus on brain inju-ry in neonates with severe asphyxia. Methods According to hospital serial number, 80 neonates with severe as-phyxia were divided into conventional treatment group (control group) (n=40), which was on the basis of symp-tomatic support treatment for the use of cerebrolysin and citicoline treatment; Astragalus injection treatment group (n=40), which, apart from the conventional treatment, Astragalus injection was given as soon as possible (within six hours after birth). The incidence of convulsions or frequent seizures convulsions and the mortality in two groups, the clinical degree of hypoxic ischemic encephalopathy (HIE) and the behavior nerve score determination were ob-served and compared. Results The incidence of convulsions or frequent seizures convulsions was significantly lower in the Astragalus treatment group than in the control group (45.00% vs 67.50%, χ24.501,P<0.05). The per-centage of the behavior nerve score determination in 7 d-8d and 12 d-14d after birth was obviously lower in the for-mer group than the latter one (48.57% vs 74.19%, χ2 4.642,P<0.05; 31.42% vs 58.06%, χ24.601, P<0.05). The mortality was not significant different between the two groups (12.50 % vs 22.50%, χ22.000, P>0.05). Conclusion For severe asphyxia neonates, on the basis of the symptomatic support treatment, the use of Astragalus injection, as soon as possible, can significantly reduce the hypoxic ischemic brain injury.

BACKGROUND: Pancreas-kidney transplantation is an effective treatment for diabetes combined with final stage renal disease. However, as the patients suffer diabetes for a long period of time, and cardiovascular system disease is complex, pre- and post-transplantation treatment is very important for successful pancreas-kidney transplantation.OBJECTIVE: To discuss immunosuppressant, coagulant, perioperative and postoperative treatment during pancreas-kidney transplantation to provide some clinical experience for pancreas-kidney transplantation.METHODS: Clinical data of 5 cases undergoing simultaneous pancreas-kidney transplantation in Department of Urinary Surgery, the 309 Hospital of Chinese PLA General Hospital between 2003 and 2008 were retrospectively analyzed to summarize the application of immunosuppressants and anticoagulant drugs and perioperative clinical monitoring focus. RESULTS AND CONCLUSION: There were 5 male patients with an average age of 43 years, and suffered type I diabetes mellitus complicated with final stage renal disease. The preoperative insulin dosage was 1.5-2.4 U/(kg·d). One case had diabetic retinopathy and fundus oculi hemorrhage for many times; two cases showed apparent coronary atherosclerotic heart disease with preoperative cardiac ejection fraction of 52% and 50%. Exocrine of transplanted pancreas had been considered by the intestinal fluid drainage. A total of 3 cases were complete rehabilitation. Of them, 1 case developed acute rejection in the first seven days after operation, but renal function restored with the hormones impact; 1 case had postoperative acute rejection of transplanted duodenum as well as intestinal fistula, eventually, transplanted pancreas was ectomized, but transplanted kidney was preserved; two cases succeeded in restoring and no complications occurred; 1 had postoperative gastrointestinal bleeding and died from multiple organ failure. Simultaneous pancreas-kidney transplantation is the most effective way to treat the diabetes mellitus with terminal nephropathy. Because of complications in the transplanted exocrine pancreas with bladder drainage, it has been replaced by the enteric drainage. Recovery of the transplanted kidney function is important for successful transplantation. After operation, oral FK should be taken when the serum creatinine returned to 300 umol/L. The application of clotting drug is one of the important factors for recovery of transplanted pancreatic function. Jejunostomy is an important therapeutic measure to prevent the reflux of intestinal juice to the transplanted pancreas in perioperative period. In the follow-up period cathartic drugs are recommended to prevent constipation and reduce the occurrence of acute pancreatitis caused by intestinal fluid reflux.

BACKGROUND: Removal of immunosuppressants in patients with recurrent tumor in long-term following organ transplantation is always a hot controversial point in academic circles. To further elevate clinical efficiency, people began to invent new immunosuppressant and studied immune efficiency of various immunosuppressant component. They tried to reduce the application of cyclosporin A (CsA).OBJECTIVE: To analyze the CsA safe withdrawal of a case of kidney recipients, at 18 years after renal transplantation, who developed bladder carcinoma and renal pelvic carcinoma at 11 years and 18 years after transplantation, respectively. METHODS: After identified diagnosis, we performed transurethral resection of bladder tumor (TURBt) and total nephroureterectomy merobladder excision. Pathologic examination revealed grade Ⅰ-Ⅱ of bladder and renal pelvic transitional cell carcinoma. After the operation, patient was treated with immune suppression program of CsA withdrawal gradually in 12 days.Within 12 days, 5 mg CsA was decreased every 3 days, and complete withdrawal was done at 12 days. The dosage of azathioprine tablets and prednisone acetate tablets was not changed. Serum creatinine levels were rechecked every 3 days during drug withdrawal, and blood pressure, urine volume, physical symptom of patients and ultrasound of transplanted kidney were observed.RESULTS AND CONCLUSION: During the three months of CsA withdrawal, the blood creatinine levels were from 65 to indicated that the CsA gradually withdrawal of a case of kidney recipients after renal transplantation, who developed transitional cell carcinoma and was performed transurethral resection of bladder tumor (TURBt) and total nephro- ureterectomy merobladder excision, was safe. No tumor relapse or diversion was found.

OBJECTIVE: To generally, regularly, and continuously evaluate single renal function in donors following living renal transplantation, to study functional changes of single kidney, and to analyze clinical feasibility of living renal transplantation. METHODS: A total of 117 living kidney donors had been selected in this study. Following renal transplantation, indicators of creatinine (Cr), glomerular filtration rate (GFR), urine microscopic examination, blood pressure were monitored and followed up so as to generally evaluate the variation of single renal function and health status of living donor. RESULTS: All 117 living donors accepted kidney transplantation successfully. There were untoward events including 2 cases for drug anaphylaxis, 8 cases for microscopic hematuria, 5 cases for proteinuria, 15 cases for urinary tract infection, 3 cases for anxious emotion after operation, and 22 cases for wound pain. The blood pressure was increased in 19 cases and glomerular filtration rate (GFR) was decreased 4-25 mL/min with the average value of (9.4±4.7) mL/min in all cases, but the rates did not exceed the normal level. Nearly all of the cases displayed creatinine rising and 43 cases still had high creatinine level in 2 months after operation. There were no significant differences between creatinine level and sex, and left or right kidney of donor, but creatinine level of patients (> 50 years old) was significantly higher than patients (< 50 years old) (P < 0.01). Indicators of all cases returned the normal value after operation; however, creatinine level of 5 cases was still abnormal (135 μmol/L). CONCLUSION: The function detail could be fluctuated after living donor renal transplantation, or even exceeded the normal value, but the variation did not impact the whole function for the single kidney and influence the holistic health for donor, thus it could be safe and feasible for living donor renal transplantation.

OBJECTIVE: Tacrolimus is widely used in organ transplant. However, the long-term effects of tacrolimus on Asian, in particular in Chinese people, are few. The aim of this study is to evaluate the efficacy and safety of long-term curative effect of tacrolimus used in kidney transplantation patients in China.DATA SOURCES: Electronic and manual retrieve of Medline database, Chinese journal full-text database, Cochrane library, and CEBM/CCD, and relevant medical journals in China were applied.DATA SELECTION: Published randomized controlled trials on tacrolimus in kidney allograft recipient were retrieved, and the data were underwent Meta analysis. Odds ratio (OR) and its 95% confidence interval (CI) were used as the measurement parameter of efficacy comparison. The statistical analyses were performed using Stata software.MAIN OUTCOME MEASURES: ①The survival ratio of patient/kidney after 1 year. ②The survival ratio of patient/kidney after 3 years. ③Rejection ratio after 3 years. ④Infection rate after 3 years. ⑤Incidence of liver dysfunction after 3 years. ⑥Blood glucose disorder after 3 years.RESULTS: A total of 3 trials were eligible for the inclusion efficacy, including 3 Chinese trials and 0 foreign trials. Results of meta-analysis indicated that tacrolimus prevented the recipients of kidney transplantation from rejection effectively in three years [OR=0.40, 95%CI (0.27-0.61), P < 0.000 1]. Tacrolimus prevented the recipients of kidney transplantation from impaired liver function in three years [OR=0.28, 95%CI (0.15-0.52), P < 0.000 1]. No statistical difference of the 1-year and 3-year survival rate of patients/ kidney was found in the patients between group tacrolimus and group cyclosporine. Statistical difference of blood glucose disorder were found in the patients between group tacrolimus and group cyclosporine [OR=2.39, 95%CI (1.41-4.05), P=0.001].CONCLUSIONS: Tacrolimus prevented the recipients of kidney transplantation from rejection and impaired liver function effectively in three years in China. No statistical difference of the 1-year and 3-year survival rate of patients/kidney was found in the patients between two groups. In addition, the main side effect of tacrolimus is blood glucose elevation.