Objective To investigate the effect of sevoflurane postconditioning on the renal injury induced by hind limb ischemia-reperfusion (I/R) in rats.Methods Twenty-four healthy male Sprague-Dawley rats,weighing 200-250 g,were randomly assigned into 3 groups (n =8 each):sham operation group (group S),group I/R and sevoflurane group (group Spo).Limb ischemia was induced by occlusion of bilateral hind limbs for 4 h followed by 6 h reperfusion.In group Spo,sevoflurane was inhaled for 6 h at the end-tidal concentration of 2.5 ％ before reperfusion,while pure oxygen was inhaled instead of sevoflurane in groups S and I/R.Blood samples were taken from the inferior vena cava at 6 h of reperfusion to determine the serum blood urea nitrogen (BUN) and creatinine (Cr) concentrations.The rats were then sacrificed and the kidney was removed for determination of superoxide dismutase (SOD) activity and contents of malondialdehyde (MDA),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and for microscopic examination.Results The levels of BUN,Cr,MDA,TNF-α and IL-6 were significantly higher,the SOD content was significantly lower (P ＜ 0.05),and the pathological damage was severer in groups I/R and Spo than in group S.Compared with group I/R,the levels of BUN,Cr,MDA,TNF-α and IL-6 were significantly decreased,the SOD content was significantly increased (P ＜ 0.05),and the pathological damage was attenuated in group S.Conclusion Sevoflurane postconditioning can reduce the renal injury induced by hind limb I/R in rats,and the reduction of oxygen radical release and inhibition of inflammatory response may be involved in the mechanism.

Objective To evaluate the clinical efficacy of expulsive therapy using alpha 1-selective adrenoblocker and prostaglandin synthetase inhibitor for distal ureteral stones.Methods 94 patients with distal ureteral stone were randomly divided into study group and control group.In study group,47 cases received tamsulosin 0.2mg daily and dielofenac rectal suppositories 50mg 2 times daily,while watchful waiting without tamsulosin and diclofenac suppository in 47 cases of control group.Observation lasted 2 weeks and also stone expelled as end point.Results No severe adverse reactions related to the drugs were noted and no patients withdrew from the study.The stone-free rate was 91.5%(43/47) of the study group and 25.5% (12/47) of the control group (P＜0.01).A mean stone expelling date of the control group was(8.9±4.3)d and that of the study group was(6.4±3.7)d(P＜0.01).Rates of renoureteral colic recurred in the study group and the control group were 4.3%(2/47) and 48.9%(23/47),respectively (P＜0.01).Conclusion Treatment of distal ureteral stones wlth tamsulosin and dielofenac suppository can increase the stone-free rate,shorten mean stone expelling date,decrease rate of renottreteral colic recurred.

Objective To evaluate the effects of remifentanil preconditioning on the renal injury induced by limb ischemia-reperfusion (I/R) in rats.Methods Twenty-seven healthy male Sprague-Dawley rats,weighing 200-250 g,were randomly assigned into 3 groups (n =9 each):sham operation group (Sham group),I/R group and remifentanil preconditioning group (RPC group).Limb ischemia was induced by clamping bilateral femoral arteries and veins for 2 h,followed by 24 h reperfusion in I/R and RPC groups.Remifentanil 1.0 μg· kg-1 · min-1 was infused via the caudal vein for 30 min before ischemia in RPC group,while the equal volume of normal saline was given in Sham and I/R groups.Blood sample was taken from the inferior vena cava at 24 h of reperfusion to measure blood urea nitrogen (BUN) and creatinine (Cr) concentrations in serum.The rats were sacrificed and the left kidney was removed for determination of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) contents,cell apoptosis and microscopic examination of pathological changes.Apoptosis index was calculated.Results Apoptosis index and concentrations of BUN and Cr in serum,TNF-α and IL-6 contents,and apoptosis index were significantly higher,and the pathological changes were more severe in I/R and RPC groups than in Sham group.Compared with group I/R,concentrations of BUN and Cr in serum,TNF-α and IL-6 contents,and apoptosis index were significantly decreased,and the pathological changes were attenuated in RPC group.Conclusion Remifentanil preconditioning can attenuate renal injury induced by limb I/R in rats,and inhibition of inflammatory responses and cell apoptosis in kidney may be involved in the mechanism.

Objective To compare the bronchial blocker and double-lumen tube for one-lung ventilation in patients undergoing esophageal cancer resection.Methods Forty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 42-63 yr,scheduled for elective esophageal cancer resection,were randomly divided into 2 groups (n =20 each):double-lumen endotracheal tube group (group DLT) and bronchial blocker group (group BB).After induction of anesthesia,the patients were intubated with a left-sided double-lumen endotracheal tube and correct positioning was verified by fiberoptic bronchoscopy in group DLT.After induction of anesthesia,the patients were intubated with a conventional single-lumen endotracheal tube,and then the bronchial blocker was inserted under the guidance of fiberoptic bronchoscope in group BB.The intubation time,one-lung ventilation time,time to achieve lung collapse,operation time,extubation time,tube malposition and hypoxemia were recorded.The lung collapse was scored at the end of operation.Hoarseness and throat sore within 2 days after extubation and pulmonary infections within 7 days after operation were recorded.Results Compared with group DLT,intubation time and time to achieve lung collapse were significantly prolonged,and the incidence of hoarseness and throat sore within 2 days after extubation was decreased in group BB (P ＜ 0.05).There was no significant difference in the one-lung ventilation time,operation time,extubation time,lung collapse score,incidence of tube malposition,hypoxemia and pulmonary infections within 7 days after operation between the two groups (P ＞ 0.05).Conclusion The efficacy of bronchial blocker is similar to that of double-lumen tube when used for one-lung ventilation in patients undergoing esophageal cancer resection.

Objective To assess the validity of a newly developed in-house ELISPOT IFN-γ release assay (IGRA) for the detection of latent tuberculosis infection among HIV infected individuals. Methods In-house ELISPOT assay were performed, together with a tuberculin skin test in 205 health controls and 110 HIV infected individuals , who had no signs of active tuberculosis at time of enrolment . Results Using the ELISPOT assay, positivity rates for the 205 health controls, 110 HIV infected individuals and 47 AIDS patients on highly active antiretrovial therapy (HAART) were 7. 3% , 24.5% , 29. 8% , respectively. These results indicated that the positive rates obtained from HIV infected individuals (include patient on HAART) was significantly higher than health controls( P ＜ 0.001). We found no significant correlation between the CD4 cell count and positivity of ELISPOT assay (P ＞0.05 ). The proportion of subjects with a positive response to ELISPOT assay were higher than the proportion of tuberculin skin test(TST) responders(P＜0.0001) in HIV infected individuals. Conclusion Our study indicates that IGRA using M. tuberculosis specific antigens are likely to retain their validity for the diagnosis of LTBI among HIV positive individuals.

ObjectiveTo investigate the expression and significance of hypoxia-inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) in liver tissues after ischemia-reperfusion injury (IRI) in rats.MethodsSixteen Sprague-Dawley (SD) rats were randomized into the IRI group and the Sham group according to the random number table, 8 rats in each group. The portal vein and branches of hepatic artery of the rats in the IRI group were clamped with the atraumatic vascular clamp. After 45 min of ischemia, reperfusion was performed for 6 h. The porta hepatis of rats in the Sham group was exposed and the hepatic blood flow was not occluded. The morphological changes of the liver tissues in two groups were observed. The serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were tested and the contents of HIF-1α and VEGF in liver tissues were determined. Data comparison between two groups was conducted usingt test.ResultsUnder light microscope, swelling, vacuolar degeneration of the liver cells, inflammatory cell infiltration, hepatic sinusoidal dilatation, disorganized hepatic cords and spotty necrosis were observed in the IRI group. The histomorphology of liver tissues in the Sham group was normal. The serum ALT and AST in the IRI group was respectively (1 007±130) and (1 307±72) U/L, which were significantly higher than (59±4) and (81±3) U/L in the Sham group (t=20.700, 48.448;P<0.05). The relative expression of HIF-1α and VEGF in liver tissues of IRI group was 1.77±0.10 and 1.86±0.05 respectively, which were significantly higher than 0.60±0.22 and 0.83±0.06 in the Sham group (t=13.623, 35.563;P<0.05).ConclusionThe expression of HIF-1αand VEGF in liver tissues increase significantly during early IRI, which may play a role in reducing the IRI of organism.

Objective: To investigate the effects of donor-specific HLA antibodies(DSA) for graft failure in un-manipulated haploidentical hematopoietic stem cell transplantation(haplo-HSCT) and the feasible treatment for DSA. Methods: HLA antibodies were examined using the Luminex-based single Ag assay for 92 patients who were going on haplo-SCT and the correlations of graft failure and DSA among the patients who had finished SCT were analyzed. Results: Of the total 92 patients who were going on haplo-HSCT, sixteen (17.4%) patients were HLA Ab-positive, including six (6.5%) patients with antibodies corresponding to donor HLA Ags (DSA-positive). Among the patients who had finished the haplo-HSCT with conventional myeloablative conditioning regimen, the engraftment rate was significantly higher in DSA (-) patients than that in DSA (+) patients [92.3% (24/26) vs 25.0%(1/4), χ²=8.433, P=0.004] and DSA was the only factor relevant with graft failure in multiple-factor analysis [OR=12.0(95% CI 1.39-103.5), P=0.024]. Strategies to decrease antibody levels were taken for 4 patients, two were their first transplantations, and the other two patients were their second haplo-HSCT. Three of the four patients were HLA-I-DSA positive and had gained donor engraftment by means of donor platelet transfusions to decreased the level of DSA, the fourth patient with both HLA-I and HLA-II DSA also gained engraftment with the treatments of TBI, rituximab and donor platelet transfusion. Conclusion DSA is one of the key factors of graft failure in haplo-HSCT. Donors should be selected on the basis of an evaluation of HLA antibodies before transplantation. If haplo-HSCT from donors with DSA must be performed, then recipients should be treated for DSA to improve the chances of successful engraftment.

ObjectiveTo investigate the impacts of portal vein arterializations (PVA) on the liver regeneration in rats with liver cirrhosis.MethodsFifty rats with liver cirrhosis model were randomly divided into PVA group (n=40) and control group (n=10) according to the random number table method. Rats in PVA group underwent PVA+portocaval shunt. Rats in control group received no treatments. The ratio of hepatic wet weight to body weight, the hepatocyte percentage of positive proliferating cell nuclear antigen (PCNA) and hepatocyte percentage in DNA synthesis phase (S phase) in each group were measured at the time of 1 week (T1), 2 weeks (T2), 4 weeks (T3) and 8 weeks (T4) after operation or enrolling in the group. Parameters of every time points inside the group were compared by one-way analysis of variance and pairwise comparison was conducted by LSD-t test. Comparison between groups was conducted byt test.Results The ratio of hepatic wet weight to body weight at T1,T2,T3,T4 in PVA group [(3.72±0.26)%, (3.81±0.27)%, (3.83±0.31)%, (3.78±0.31)%] were signiifcantly increased compared with that in control group [(2.84±0.37)%] (t=6.11,6.64,6.49,6.17;P<0.05). The hepatocyte percentage of positive PCNA at T1, T2, T3, T4 in PVA group [(76±6)%, (69±8)%, (20±5)%, (15±4)% ] were signiifcantly increased compared with that in control group [(11±2)%] (t=34.48, 22.87,5.69,2.93;P<0.05). The hepatocyte percentage of positive PCNA at different time points inside the PVA group decreased gradually as time extended, where signiifcant difference was observed (F=316.20,P<0.05). The hepatocyte percentage in S phase at T1, T2, T3, T4 in PVA group [(27.0±1.2)%, (20.5±1.4)%, (16.2±1.3)%, (13.5±1.3)%] were signiifcantly increased compared with that in control group [(11.6±1.9)%] (t=21.97, 12.15, 6.30, 2.68;P<0.05). The hepatocyte percentage in S phase at different time points inside the PVA group decreased gradually as time extended, where signiifcant difference was observed (F=208.00,P<0.05).ConclusionsPVA can effectively promote liver regeneration in rats with liver cirrhosis and the effect declines as time extends.

Objective To improve the recognition of therapy-related acute myeloid leukemia (t-AML). Methods One patient who was diagnosed as AML with inv (16) following treatment of Hodgkin lymphoma (HL) was reported. The pathomechanism, diagnosis, treatments and prognosis of t-AML were systematically studied by reviewing a series of literature. Results A 36-year-old female with a history of HL 2 years ago was diagnosed t-AML. Karyotype analysis demonstrated inv (16) and the fusion gene of CBFβ/MYH11 was positive by polymerase chain reaction (PCR). The fusion gene of CBFβ/MYH11 was still positive after receiving 3 courses of chemotherapy. The leukemia reached completely molecular biological remission after receiving haploidentical peripheral blood stem cell transplantation. The patient has now survived 1.5 years with leukemia free and in a good performance. Conclusions The t-AML is difficult to treat, but it is heterogeneous. Cytogenetics and molecular biology have important implications for the prognosis of t-AML. Currently, allogeneic hematopoietic stem cell transplantation is the only effective way to cure t-AML.

Objective:To discuss the clinical characteristics of the Pneumocystis jirovecii pneumonia (PCP) in the non-HIV-infected blood disease patients, and to analyze its risk factors, treatment methods, prognosis and prevention measures.Methods:A female patient aged 18years old was confirmed as acute myeloid leukemia (AML) , and experienced dyspnea, chest congestion and hypoxaemia during the recovery period of hemogram after chemotherapy.The chest CT showed the bilateral lung diffuse ground glass density images.The patient had a dry cough and the oxygen saturation was gradually decreased to 75％5dafter antibacteriological treatment.A repeat chest CT showed enlarged diffuse ground glass density images on both lungs.Considering about the possibility of PCP, the patient received oral trimethoprim/sulfamethoxazole (TMP/SMX) 1g, once every 6h, in combination with caspofungin.Results:Two days later, the symptoms of the patients were not improved.The patient was transferred to ICU and was diagnosed PCP by bronchoalveolar lavage.The patient was switched to oral TMP/SMX2g, once every 8h, in combination with caspofungin.Meanwhile, the patient received bi-level positive airway pressure ventilation (Bipap) for the increased work of breathing.Five days later, the symptoms of the patients were improved and the Bipap was stopped.The patient got better and discharged 5dlater.The patient continuely received oral TMP/SMX 2g, once every 8hfor 36d.Conclusion:Prevention of PCP should be focused, in the non-HIV-infected blood disease patients receiving chemotherapy.Diagnosis of PCP should be considered in these patients without prevention who once have suspected clinical manifestation of PCP in non-granulocytic phase.Early empirical treatment of PCP and ICU management in the non-HIV-infected blood disease patients with acute respiratory failure are the keys to reduce death and improve the prognosis of PCP.