Objective To compare the anesthesia effect and adverse effect of subarachnoid block anesthesia with different doses of sufentanil combined with bupivacaine 7.5 mg in aged patients,and explore the suitable dosage of sufentanil.Methods Eighty aged patients with ASA grade Ⅰ-Ⅲ undergoing elective lower limb surgery were divided into 4 groups by random digits table and each group was in 20 cases:group Ⅰ received bupivacaine 7.5 mg,group Ⅱ received bupivacaine 7.5 mg+sufentanil 2.5 μg,group Ⅲ received bupivacaine 7.5 mg+ sufentanil 5.0 μg,group Ⅳ received bupivacaine 7.5 mg+ sufentanil 7.5 μg.The vital signs,degree of motor and sensory nerve blockade and adverse effect were observed.Results Compared with base blood pressure,systolic blood pressure(SBP)and diastolic blood pressure(DBP)in group Ⅰ was significantly decreased after intrathecal injecton 15,30,45,60 minutes(P ＜0.05).There were no significant differences in the degree of motor nerve blockade in four groups(P ＞ 0.05).The time of sensory nerve blockade in group Ⅰ[(194 ± 58)min]was significantly shorter than that in group Ⅱ,Ⅲ,Ⅳ[(255 ±44),(242 ±58),(308 ± 123)min](P ＜0.05).The time of sensory nerve blockade in group Ⅳ was significantly longer compared with group Ⅱ and Ⅲ(P ＜ 0.05).The number of pruritus in group Ⅳ(10 cases)was significantly more than that in group Ⅰ and Ⅱ(0,4 cases)(P＜0.05).Conclusion Subarachnoid block anesthesia with sufentanil 2.5 or 5.0 μg combined with bupivacaine 7.5 mg in aged patients is safe and effective.

Objective To investigate the risk factors for delayed graft function (DGF) under-(going) cadaver renal transplantation.Methods Twenty-four relative variables were analyzed by SPSS11.0 statistical software. Using chi-square analysis method, the influence of these variables on DGF was retrospectively studied. Logistic regression analysis was done to assess and rank the relative risk of potential variables.Results The overall incidence of DGF was 5.01 %. Chi-square analysis (revealed) that the risk factors for DGF were identified as: cold ischaemia time, warm ischaemia time, recipient hypovolaemia, number of previous transplants, allosensitisation of the recipient, ATN, (accelerated) rejection, cyclosporine nephrotoxicity, ureteral leakage obstruction. Logistic multivariate analysis showed that there were 8 risk factors contributing to DGF.Conclusion DGF is a common (allograft) complication in the immediate posttransplant. There are many risk factors contributing to this condition. The basic change is ischemia-reperfusion injury. It is very important to comprehend the risk (factors) thoroughly in order to prevent them effectively.

Obiective To evaluate the current status of studies on interventional recallalization of fallopian tube.Methods According to the standard of evidence-based medicine,literatures were analyzed by two readers in three time periods:1997 to 2000,2001 to 2004 and 2005 t0 2008.Two separate evaluation results were tested by the statistical method Kappa to test its consistency.Scores of clinical controlled trials (CCT)and randomized controlled trials(RCT)were calculated according to Jadad score scale.The accurate criteria of case selection,case exclusion,and effect determination;the method of randomization;the number of samples:the comparability of baseline;the blinded procedure;the therapeutic method;the method of statistical analysis:the follow-up cases; the drop-out cases and the conclusions derivation of RCT and CCT into descriptive analysis were evaluated Results One hundred and fifty seven therapeutic articles were searched and 30 RCT and CCT articles(25 RCT and 5 CCT)were analyzed.The Kappa value was 0.85 and P＜0.05 indicating that the evaluation was in good consistency.2,15 and 8 RCT received 0 point,1 point and 2 points respectively in Jadad score scale.RCT and CCT contained 9 articles(30.0%)fulfilled the accurate criteria of case selection and exclusion:12 articles(40.0%)met the accurate criteria of effect determination:4 articles(13.3%)utilized the definite method of randomization;27 articles (90.0%)had the number of sample beyond 60;14 articles(46.7%)met the baseline comparability;only 1 article(3.3%)used the single-blinded method,17 articles(56.7%)utilized the method of statistical analysis;13(43.3%)mentioned follow-up in articles;4(13.3%)mentioned drop-out cases in the articles and 14(46.7%)articles had the conclusions derived by considering the statistical significance and clinical significance.Conclusion The quality of studies on interventional recanalization of fallopian tube is poor and could not meet the standard of evidence-based medicine.

OBJECTIVE: Some studies have documented that living donor kidney transplantation has a better clinical results than cadaveric donors, however, it is poorly understood whether different living-related donors has different effects on kidney transplantation. The aim of this study is to discuss the clinical results of different living-related donors on kidney transplantation, in addition, to analyze the related problems including the donor selection, and relation of type matching with transplantation results. METHODS: Donors comprise 36 males and 58 females, aged (42.6±8.8) years. There were 72 males and 22 females received kidney transplantation, aged (33.9±8.7) years. Except for 6 cases being donated by spouse, 35 cases were donated by parents and 53 cases were donated by brothers and sisters. As to human leucocyte antigen (HLA) matching, 18 cases were full matched, 2 cases shared one-haplotype mismatched, 5 cases with 2-haplotype mismatched, 2 cases with 3-haplotype mismatched, 2 cases with 4-haplotype mismatched, and 1 case with 5-haplotype mismatched, 10 cases with full mismatched. Totally 85 cases had identical blood type, 9 cases had blood type compatibility. All recipients were negative for panel reaction antibody with smaller than 10% of lymphocytotoxicity tests prior to transplantation. RESULTS: All donors recovered well. Acute rejection episodes occurred in 8 patients, 4 cases donated by parents, 3 cases donated by siblings and 1 case donated by spouse. One recipient donated by spouse suffered accelerated rejection and delayed graft function recovery occurred. The renal function recovered in 5 weeks post-operation. All cases were reversed successfully by high intravenous dose of methyl-prednisolone or polyclonal anti-T-cell antibodies. A 6 month to 10 years follow-up showed all the donors kept normal kidney function without impairment of life quality, and 92 recipients with 92 grafts survived yet. Two recipients were dead: one due to serious pulmonary infection, and the other due to heart failure. 2 recipients underwent chronic allograft nephropathy. CONCLUSION: Living-related donor kidney transplantation has optimal HLA matches, low incidence of acute rejection and long-term surviving ratio and blood relative, which is better for renal transplantation.

Objective To compare the difference of clinical and laboratory characteristics between the patients undergoing uninephrectomy for urologic diseases and healthy living kidney donors.Methods The change of blood pressure,renal function,blood routine examination,urine protein,plasma electrolytes and blood fat in two groups preoperatively and at one week,one month,6 months and one year postoperatively were retrospectively assessed.Of the 65 living kidney donors,12 were male and 53 were female.Among 354 cases of uninephrectomy for urologic diseases,there were 291 cases of hpper urinary tract tumor,56 cases of hydronephrosis and 7 cases of severe kidney injury.Results Compared to the preoperative status,there was significant difference of hemoglobin,creatinine,urea nitrogen and urine protein in two groups.Clinical and laboratory characteristics of two groups became stable at one months postoperatively,and could reach the preoperative level at 6 months or one year postoperatively.But the creatinine was 25.71%higher than the preoperative level in healthy donors and 25.49%in patients undergoing uninephrectomy for urologic diseases.There was no significant difference between the two groups at one year postoperatively.Conclusions Two groups are safety after nephrectomy.There is no significant difference of clinical and laboratory characteristics between the 2 groups.Strict donor selection,appropriate pretransplantation evaluation,careful operation and postoperative health consulting play important roles in donors;safety and health.

Objective To investigate the effect of berberine anti macrophages apoptosis, initially to determine the concentration of anti-apoptosis and to explore its mechanisms of treatment in atherosclerosis (AS). Methods Apoptosis of RAW264.7 macrophages is induced by 0.5 μmol/L Tg and 50 μg/ml Fuc. The cell survival rate and apoptosis rate was detected by MIT and flow cytometry, respectively. Results There was statistical significance between the berberine group of 800 μg/ml and normal group in the cell sur-vival rate(P<0.01). With the decline in concentration of berberine, the cell apoptosis rate showed a down-ward trend, berberine (0.02-0.63 μg/ml) effectively inhibited the cell apoptosis induced by Tg and Fuc. Conclusion Berberine group has little impact on the cell proliferation. Berberine can effectively inhibit the cell apoptosis induced by Tg and Fuc.

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.

ObjectiveTo verify the efficacy and safety of conversion from cyclosporine (CsA) to tacrolimus (Tac) in renal transplant recipients. MethodsThe clinical data of conversion from CsA to Tac in renal transplant recipients were retrospectively analyzed. In 97 patients undergoing kidney transplantation, there were 62 cases of chronic allograft nephropathy (CAN), 21 cases of refractory renal allograft rejection, 8 cases of hepatic impairment, and 6 cases of gingival overgrowth and hirsutism. The patients were followed up with renal function, hepatic function, blood fat, pressure,glucose,acute rejection incidence, patients/kidney survival rate,and adverse drug reaction for 3 years.ResultsThe renal function of patients with CAN and refractory acute rejection was greatly improved after conversion from CsA to Tac treatment at the first year (P＜0. 05) ,and steady at the 2nd or 3rd year. The conversion treatment could greatly improve the hepatic function of patients with dysfunction of liver, improve the gum hypertrophy and hypertrichosis results from CsA. The 1- and 3-year patients/kidney survival rate after conversion from CsA to Tac was 100 ％/97. 9 ％ and 100 ％/92. 8 ％, respectively. The conversion treatment showed a significantly lower degree of plasma cholesterol, low density lipoprotein, triglyceride, and blood pressure (P ＜ 0.05). Incidence of pathoglycemia, diarrhea or anepithymia,and tremor after conversion treatment was 13.4 ％ (13/97),2. 1％ (2/97) and 5. 2 ％ (5/97),respectively. There were no serious pulmonary infection and tumor during the observation period. ConclusionThe mid-long term effect of conversion from CsA to Tac in patients with kidney transplantation is safe and effective.

Objective To investigate correlation between microRNA (miR-494) and TH 17 cell differentiation in murine cervical heterotopic cardiac transplant model.Method The heterotopic cardiac transplant models of Balb/c→C57BL/6 mice were established as experimental group,and those of C57BL/6→C57BL/6 mice as control group.Real time-polymerase chain reaction(PCR) was used to detect miR-494 and interleukin(IL)-17A mRNA expression in the grafts.CD4+ T cells,CD8+ T cells and CD45+ myeloid cells were isolated from the grafts,and miR-494 and IL-17 mRNA expression was detected.In vitro,lymphocytes in the spleen from C57BL/6 mice were harvested,and CD4+ T cells were isolated with MACS and then stimulated to TH 1,TH 2,TH 17,Treg subset cells.The expression of IL-17A mRNA and miR-494 in different T subsets was examined by Reverse transcription-polymerase chain reaction(RT-PCR).Result Two grafts from each study group were harvested on the 7th day post-transplantation.In experimental group,the IL-17A mRNA expression was increased,while the expression of miR-494 was decreased as compared with control group with the difference being significant between two groups.The expression of IL-17A rnRNA in CD4+ T cells of the grafts was significantly increased,while that expression of miR-494 was decreased.In vitro,the expression of miR-494 in TH 17 cells was significantly lower than that in TH 1,TH 2 and Treg cells.Conclusion miR-494 is related closely to TH 17 cells differentiation in the transplant rejection,which may play a role in transplant rejection through regulating TH 17 cells.

Objective To study the effect of electrical stimulation breath training on lung function of patients following pulmonary lobectomy. Methods 62 patients following pulmonary lobectomy were randomly allocated into experimental group (n=30 )and control group (n=32). The experimental group received a 4-week supervised electrical stimulation breath training program using an electric stimulus feedback trainer (20mins per time, 3 times per week);The control group received postoperative routine nursing. Cadiopulmonary function evaluation of 2 groups were tested before and after the experiment. The evaluation included the 6-min walking test (6MWD), FVC, FEV1,W,AT and VO2max/kg. Results After 4 week training, the value of 6MWD,W,FVC,FEV1 all improved, compared to the baseline value (P < 0.05) and the value of 6MWD,W,FVC,FEV1 were more obvious in experimental group, compared to control group(P<0.05). The AT value and the VO2max/kg value increased than the baseline value (P<0.05)and the improvement degree was more remarkable in experimental group than that in control group (P<0.05). Conclusion Electrical stimulation breath training can improve cardiopulmonary function of the patients following pulmonary lobectomy.