Objective To evaluate the actual mismatch risk for KIR genes,KIR ligand HLA-C gene and KIR ligand HLA-Bw4I80 related genes in kidney transplant recipients and their donors.Method KIR genes,KIR ligand HLA-C gene and KIR ligand HLA-Bw4I80 related genes were analyzed in 322 recipients and their donors who received kidney transplantation.The effect of mismatches on acute rejection after transplantation was studied as well.Result In 322 cases of recipients and their donors,average mismatch risk for KIR-L gene was 4.73％,9.10％ for KIR-S gene and 1.95％ for KIR ligand HLA-C gene respectively.There were 245 cases (76.09％) of KIR ligand HLA-Bw4I80 related genes mismatch and 77 cases (23.91 ％) of match resepctively.There was no statistically significant difference in AR rate between KIR ligand HLA-Bw4I80 related genes mismatch group and match group (8.16％ in 245 vs.7.79％ in 77) (P＞0.05).AR reversal rate in mismatch group and match group was 95.0％ and 66.7％ (P＞0.05).Conclusion The mismatch risk for KIR ligand HLA-Bw4I80 related genes was even common between kidney transplant recipients and their donors,and this specific mismatch may be of benefit to patients who undergo actuate rejection.Further study is still required.

Objective Analyse the causes,diagnosis and treatment for delayed hemorrhage after distal radical gastrectomy.Methods Retrospective study on 45 patients combined with intro-abdominal hemorrhage after distal radical gastrectomy from January 2008 to June 2013.Results Thirteen patients combined with delayed hemorrhage in these 45 patients,all of 13 patients had intro-abdominal hemorrhage in 1week to 4 weeks after operation.And 5 of the 13 patiens were intermittent intro-abdominal hemorrhage 1 week after operation,these patients were demonstrated the blood come from gastroduodenal artery pseudoaneurysm fracture by CT and DSA examine,and they were cured by interventional embolization.Other 8 patients were marginal ulcer hemorrhage diagnosed by gastroscope,and they stoped bleeding with the help of gastroscope.Conclusions The causes of delayed hemorrhage after distal radical gastrectomy were complicated,and CT,DSA and endoscope can use for diagnosis.What was more,interventional embolization and endoscope were helpful for curing the intro-abdominal hemorrhage,avoiding re-operation.

Objective To investigate the safety and feasibility of intraluminal brachytherapy using iodine-125 seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice.Methods Clinical data of 17 consecutive patients,from January 2010 to February 2015,diagnosed with pancreatic ductal adenocarcinoma (4 cases of T4 N0 M0 and 13 of T4 N1M0) with obstructive jaundice and received intraluminal brachytherapy using iodine-125 seed strand were collected and analyzed retrospectively.Liver function was evaluated using paired-samples t test.The iodine-125 seed strand radiation doses were calculated using iodine-125 radiation field distribution calculation software (version 0.1,Institute of Radiation Medicine,Fudan University,Shanghai,China) based on the American Association of Physicists in Medicine TG43U1 brachytherapy formula.Obstruction free survival and overall survival were calculated using the Kaplan-Meier method.Complications were assessed according to the CTCAE 4.0 criteria.Results The estimated mean accumulating dose (r =5 mm,240 days) was 167.2Gy,from 164.19Gy to 170.05Gy.The mean and median obstruction free survival time were (9.62 ± 1.47) months (95％CI:6.73-12.50) and (7.26 ± 1.71) months (95 ％CI:3.90-10.62).The mean and median overall survival time were (9.89 ± 1.59) months (95％CI:6.78-13.00) and (7.26 ± 1.71) months (95 ％ CI:3.90-10.62),retrospectively.Total bilirubin and conjugated bilirubin decreased significantly after the therapy.Two patients had adverse event of Grade 3,one of Grade 4.Stent dysfunction occurred in 1/17 (5.9 ％) patients.Conclusions Intraluminal brachytherapy using iodine-125 seed strand might be considered as a safe treatment option for the locally advanced pancreatic duct adenocarcinoma complicated by obstructive jaundice.

Objective To evaluate the prognostic value of blood lactate (Lac) level in sepsis patients with or without diabetes.Methods 106 patients admitted to intensive care unit (ICU) of Zhongshan Hospital Affiliated to Fudan University from April 2015 to November 2016 were enrolled. The patients with age > 18 years and the length of hospital stay > 24 hours were included. Records including blood Lac, serum creatinine (SCr), white blood cell count (WBC), platelet count (PLT), sequential organ failure assessment (SOFA) on the first day of admission; minimum oxygen index (PaO2/FiO2) in 3 days after admission; mechanical ventilation, whether there was a history of diabetes, usage of biguanides, etiology control treatment, usage of continuous renal replacement therapy (CRRT) were collected. According to the level of blood Lac patients were divided into high Lac group (Lac > 2 mmol/L) and low Lac group (Lac ≤ 2 mmol/L);based on their diabetic history, sepsis patients were divided into the diabetes group and non-diabetes group. The survival curve of each group was analyzed by Kaplan-Meier regression analysis, and the factors influencing the prognosis were analyzed by multivariate Cox regression analysis.Results There were 76 males and 30 females sepsis patients, with an average age of (68.1±14.7) years old. In the 51 patients of low Lac group, there were 7 patients who suffered from diabetes. While in the 55 patients of high Lac group, there were 12 patients who suffered from diabetes. Compared with low Lac group, high Lac group had a higher age, higher SOFA score, and a lower proportion of patients who had the treatment of etiology control (allP < 0.05). There was no significant difference of blood Lac in sepsis patients with diabetes and those without diabetes (mmol/L: 3.03±2.73 vs. 2.81±2.40,P > 0.05). Kaplan-Meier survival curve analysis showed that the 90-day survival rate in the high Lac group was significantly lower than that in the low Lac group (56.36% vs. 90.20%,χ2 = 0.697,P = 0.008). The high Lac group without diabetes had lower survival rate, and the 90-day survival rate was significantly lower than that of the low Lac group without diabetes (58.14% vs. 90.90%,χ2 = 7.152,P = 0.007); there was no significant difference in 90-day survival rate between the high Lac group and the low Lac group with diabetes (50.00% vs. 85.71%,χ2 = 0.012,P = 0.914). Multivariate Cox regression analysis showed that blood Lac was an independent risk factor for the prognosis of sepsis patients [odds ratio (OR) = 3.863, 95% confidence interval (95%CI) = 1.237-12.060,P = 0.020]. After stratification according to their diabetic history, the blood Lac was an independent risk factor for the prognosis of sepsis patients without diabetes (OR = 4.816, 95%CI = 1.407-15.824, P = 0.010), but the blood Lac had no effect on the prognosis of sepsis patients with diabetes (OR = 0.000, 95%CI =0.000-1.103,P = 0.270).Conclusions The predictive value of blood Lac on sepsis patients with or without diabetes was different. The blood Lac was related with the prognosis of sepsis patients without diabetes, while further study should be conducted for the prognostic value of blood Lac in sepsis patients with diabetes, and it's possible to increase the cut-off-point of Lac level in these patients.

OBJECTIVETo determine the optimal dose range (therapeutic window) of mycophenolate mofetil (MMF) for preventing acute graft rejection following renal transplantation.

METHODSThe trough concentration of MMF (MPA-C0) at 12 h after oral administration of the drug (two doses daily given at an interval of 12 h) was monitored in 110 renal transplant recipients within a month, in 2-3 months, and over 4 months after the transplantation using EMIT method. The occurrence of acute graft rejection and drug toxicity were observed in all the patients during the one-year follow-up.

RESULTSs The incidence of acute graft rejection after transplantation was 13.64% (15/110) in these patients. Drug toxicity and complications occurred in 32.73% (36/110) of the patients, including 12 cases with reduced white blood cell counts, 10 with MMF cid-associated diarrhea, 10 with infection, 4 with liver function damage. Acute rejection was successfully reversed after methylprednisolone treatment and drug toxicity was managed by corresponding treatment and adjustment of MMF dose. No deaths or graft removal occurred in these patients. The ROC curve showed that a MPA-C0 of 1.40-2.80 mg/L was optimal in preventing acute rejection after the transplantation and reducing adverse drug effects.

CONCLUSIONMonitoring MPA-C0 and individualized MMF dosing help to prevent acute graft rejection, reducing drug toxicity and complications, and improving graft survival rate after renal transplantation.

Graft Rejection ; drug therapy ; prevention & control ; Graft Survival ; Humans ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Kidney Transplantation ; Methylprednisolone ; Mycophenolic Acid ; administration & dosage ; analogs & derivatives ; therapeutic use ; Survival Rate ; Time Factors

OBJECTIVETo discover and identify differentially expressed genes associated with colorectal adenoma formation and the role of RegIV in colorectal adenoma differentiation.

METHODSA subtracted cDNA library was constructed with cDNAs that were isolated from either the normal mucosa or adenoma tissue of a single patient. Suppressive subtractive hybridization (SSH) combined with virtual northern blotting was used to characterize differentially expressed genes and contigs were assembled by electronic cloning (in silico cloning) with the EST database. Semi-quantitative RT-PCR was performed in 9 colorectal adenomas.

RESULTSThe amino acid sequence was determined with open reading frame (ORF) prediction software and was found to be 100% homologous to the protein product of RegIV (a novel gene isolated from a large inflammatory bowel disease library). RegIV was found to be highly expressed in all of the adenoma samples (9/9) compared with the normal mucosa samples, while 5/6 cases showed RegIV to be more strongly expressed in adenocarcinoma.

CONCLUSIONRegIV may play an important role in the initiation of colorectal adenoma differentiation, and its detection may be useful in the early diagnosis of colorectal adenoma formation.

Adenoma ; genetics ; metabolism ; Blotting, Northern ; Colorectal Neoplasms ; genetics ; metabolism ; Humans ; Lectins, C-Type ; biosynthesis ; genetics ; Nucleic Acid Hybridization ; Pancreatitis-Associated Proteins ; Prognosis ; Reverse Transcriptase Polymerase Chain Reaction

Objective To compare the effects of propofol combined with fentanyl or dezocine on painless abortion and the influence on body movement.Methods From July 2016 to May 2017,240 patients with voluntary painless abortion who aged 19-45 years old in the Second People's Hospital of Linhai,were randomly divided into 3 groups according to the digital table ,with 80 cases in each group.D group was given propofol and dezocine ;F group was given propofol combined with fentanyl ;C group was the control group and was treated with propofol intravenous anesthesia,the three groups were given propofol added according to the specific situation.The operative time,recovery time and the total amount of propofol were compared among the three groups ;and the pain visual analogue scale (VAS) at 0min,15min,30min,1h,3h were comparedamong the three groups ;The incidence of respiratory depression and other adverse reactions were statistically analyzed in three groups.Results The operation time,recovery time,the total dosage of propofol in D group were (4.5 ±0.7)min,(1.2 ±0.3)min and (136.8 ±14.5)mg,respectively, which in F group were (4.6 ±0.8)min,(1.3 ±0.2)min and (139.6 ±12.1)mg,respectively,there were no statisti-cally significant differences between the two groups (all P＞0.05).The recovery time and total dosage of propofol in D group and F group were lower than those of C group [(2.4 ±0.6) min,(168.7 ±18.9) mg](t＝25.298,27.287, 11.977,27.287,all P＜0.05).The VAS scores at postoperative 0min,15min,30min,1h,3h in D group were lower than those in F group and group (t＝34.785,25.044,25.043,22.349,28.622,48.809,42.278,40.000,42.278, 40.000,all P＜0.05).The VAS scores at postoperative 0min,15min,30min,1h in F group were lower than those of C group(t＝36.978,24.406,19.846,24.406,all P ＜0.05).The incidence rates of nausea,sedentary,respiratory depression,hypotension in D group were 1.3%(1case),2.5%(2cases),1.3%(1case),0.0%(0cases), resperctively,which in F group were 0.0%(0cases),3.8%(3cases),3.8%(3cases),2.5%(2cases),which in D group,F group were lower than those in C group [6.3%(5cases),16.3%(13cases),11.3%(9cases),15.0%(12cases)](χ2＝3.925,3.657,3.925,3.657,5.889,3.152,3.152,3.657,all P＜0.05).Conclusion Propofol combined with dezocine and fentanyl used in painless abortion have good effect ,and the body movement is less ,but propofol combined with dezocine has less postoperative pain degree.

Objective To investigate the clinical treatment and outcomes of severe community-acquired pneumonia (CAP) complicated with mediastinal emphysema after renal transplantation. Methods Clinical data of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation were retrospectively analyzed. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) and oxygenation index were recorded when the patients were admitted to the intensive care unit (ICU). The complications of mediastinal emphysema and corresponding treatment were observed. The treatment course during the ICU, mortality rate in ICU, ICU stay time and hospital stay time were recorded. All patients underwent pathogenic examinations. Results The APACHEⅡ score of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation was 14 (8-21) scores and the oxygenation index was 150 (133-189) mmHg. Among 9 patients, 3 cases were infected by bacteria alone, 3 cases were infected by bacterial infection combined with viral infection, 1 case was infected by mycobacterium tuberculosis complicated with other bacterial infection and 1 case was viral infection. No pathogenic evidence was detected in the remaining 1 patient. Mediastinal emphysema complicated with subcutaneous emphysema occurred in 7 cases and pneumothorax occurred in 6 cases. Treatment methods included anti-infection, modified immunosuppressive program, mediastinal drainage, thoracic closed drainage, subcutaneous incision and extracorporeal membrane oxygenation (ECMO) treatment. Six patients received invasive mechanical ventilation (IMV), 2 received non-invasive positive pressure ventilation (NIV) and 1 received high-flow nasal oxygen cannula (HFNC). Among 9 patients, the mortality rate in ICU was 6/9, the remaining 3 patients were recovered and discharged, the ICU stay time was 26 (17-40) d, and the total hospital stay time was 27-61 d. Conclusions Mediastinal emphysema is a serious complication of patients presenting with severe CAP after renal transplantation with a high mortality rate. For these patients, imaging evaluation, timely drainage and full sedation should be strengthened, and ECMO treatment should be delivered when necessary.

Objective To evaluate the safety and efficacy of brachytherapy with 125I seed strand in treating implanted main portal vein tumor thrombus (MPVTT) in experimental rabbits.Methods VX2 tumor cell line was implanted in the main portal vein (MPV) of 32 New Zealand white rabbits to establish MPVTT models.The rabbits were randomly divided into the treatment group (group T,n=16) and the control group (group C,n=16).125I seed strand was implanted in the MPVTT of the rabbits of group T,while blank seed strand was implanted in the MPVTT of the rabbits of group C.After the implantation,the changes in general condition,body weight and laboratory testing results were recorded.Two weeks after the treatment,every 8 rabbits from each group were sacrificed,and the specimens were collected and sent for pathological examination.The remaining rabbits were fed till they died,and then autopsy was conducted.Multi-slice spiral CT manifestations,histopathological findings,Ki-67 labeling index and apoptosis index were used to assess the curative effect,and the results were compared between the two groups.Results At each observation time point after brachytherapy,the weight loss of the experimental rabbits was more obvious in group C than in group T.No statistically significant differences in liver functions and white blood cell count existed between the two groups (P＞0.05).The mean MPVTT volume of group T and group C were (565.40±220.90) mm3 and (2 269.90±437.00) mm3 respectively (P＜0.001);the Ki-67 labeling indexes were (4.14±1.84)％ and (33.82± 6.07)％ respectively (P=0.001);the median survival days were (39.50±2.37) d and (27.38±1.22) d respectively (P=0.001).Conclusion For the treatment of implanted MPVTT in experimental rabbits,brachytherapy with 125I seed strand is safe and effective.

OBJECTIVETo investigate the relationship between platelet parameters and delayed graft function (DGF) early after kidney transplantation.

METHODSWe retrospectively analyzed the clinical data of 232 recipients within 2 months following kidney transplantation performed between January, 2009 and September, 2013, among whom 29 experienced DGF. The laboratory data of the preoperative and postoperative platelets were collected from all the recipients.

RESULTSCompared with the preoperative levels, the platelet number (PLT) and platelet hematocrit (PCT) were decreased on day 1 after kidney transplantation and was the lowest on day 5 (P<0.05), followed by gradual increase till reaching the highest levels on day 15 (P<0.05) and recovery of the preoperative level in days 30-60. The average platelet volume (MPV), platelet volume distribution width (PDW) and large platelet ratio (P-LCR) were increased on day 1, highest on day 7 (P<0.05), and reduced to the preoperative level on day 15, but then rose again slowly. MPV and P-LCR in days 30 to 60 and PDW in days 45 to 60 were significantly higher than the preoperative levels (P<0.05). The patients with DGF showed lowered PLT than those without DGF since day 2, and this difference was statistically significant in days 7 to 10, while PCT remained comparable between the two groups; MPV, PDW, and P-LCR were higher in DGF group than in DGF-free group with statistically significant difference on days 7, 10, and 15 (P<0.05).

CONCLUSIONPlatelet function is associated with postoperative renal graft function recovery, and platelet parameters can provide new markers for monitoring the occurrence and reversion of DGF.

Biomarkers ; Blood Platelets ; physiology ; Delayed Graft Function ; Humans ; Kidney Transplantation ; Platelet Activation ; Platelet Count ; Postoperative Period ; Retrospective Studies