Objective To analyze the diagnosis and treatment of iliac pseudoaneurysms following renal transplantation.Method The data of two patients with pseudoaneurysm who underwent kidney transplantation were retrospective analysied.Result One case with pseudoaneurysm received transplant nephrectomy,and pathological examination diagnosed mucoraceae infection; the other patient received endovascular treatment and amphotericin B therapy,endly died of hemorrhagic shock.Conclusion The development of pseudoaneurysms at the kidney transplantation recipients with the same donor results in high rates of mucormycosis.They should take anti-fungus therapy and operation as early as possible.

Objective To observe the effect of hybrid renal replacement therapy (sustained lowefficiency hemodiafiltration) in recipients with delayed graft function (DGF) after kidney transplantation.Methods In 33 kidney transplant patients with DGF,there were 15 cases subject to sustained low-efficiency hemodiafiltration (SLEDF group),18 cases subject to hemodialysis (HD group).The renal function was tested,and the expression levels of complements C3,C4,and CRP,IL-1β,IL-6,TNF-α were detected before and after therapy.Results In SLEDF group,the renal function recovered in (29 ± 13) days after therapy,and in (47 ± 21) days in HD group.After therapy,the BUN and Scr in both two groups were lower than before (P＜0.01).After therapy,the levels of IL-1β,IL-6 and TNF-α were also lower than before in two groups,and the levels were lower in SLEDF group than in HD group (P＜0.05).The levels of complements C3,C4,and CRP in two groups were decreased after therapy,but there was no statistically significant difference (P＞0.05).Conclusion SLEDF can decrease the level of SCr,BUN and some cytokines in recipients effectively,and It's helpful to recovery of the renal function.SLEDF can be used by DGF recipients in transit time.

BACKGROUND: Presently, acute rejection following renal transplantation remains a risk factor for chronic rejection and graft function injury, How to non-invasive, rapid and exact diagnosis and prompt treatment is important. OBJECTIVE: To investigate early diagnosis and post-treatment expression of urine monocyte chemoattractant protein-1 (MCP-1) in the acute rejection after renal transplantation, through detecting the association of the urine MCP-1 variation according to some cases of nephridial tissue biopsy. METHODS: We selected 62 chronic renal failure patients who received renal homotransplantations in the Department of Renal Transplantation of Zhengzhou People's Hospital from October 2008 to February 2009. The stable renal function group contained 42 patients with stable renal function following renal transplantation. Acute rejection group contained 20 patients with acute rejection following renal transplantation. We chose 10 patients who examined no abnormalities in the Medical Examination Center of Zhengzhou People's Hospital to detect their urine sample as control group. All patients following renal transplantation underwent conventional immunosuppression. In addition, patients in the acute rejection group were treated with antilymphocyte globulin or methylprednisolone reinforced impact therapy. MCP-1 mass concentration changes were measured by double antibodies sandwich enzyme linked immurosorbent assay. RESULTS AND CONCLUSION: Compared with control group, no significant change was determined in urine MCP-1 mass concentration in the stable renal function group (P > 0.05). The urine MCP-1 mass concentration was significantly increased in the acute rejection group (P< 0.01). Compared with pretreatment, urine MCP-1 mass concentration was significantly decreased following treatment in 20 patients from the acute rejection group (P < 0.01). Of them, 17 cases had relieved clinical symptom, and normal auxiliary examination, and their urine MCP-1 mass concentration was close to the control group; 3 cases were inefficient, whose urine MCP-1 mass concentration was greater than the control group. Eight cases received nephridial tissue biopsy, and kidney pathology demonstrated acute rejection of transplanted kidney, which was similar to urine MCP-1 mass concentration in the acute rejection group prior to treatment (P > 0.05). These indicated that the level of MCP-1 in urine can non-invasively diagnose acute rejection following renal transplantation in an early phase, and monitor therapeutic efficacy. This may be associated with renal pathological injury during acute rejection following renal transplantation.

Objective To investigate the effect of short course chemotherapy combined with broncho-vaxom on the prognosis of new smear positive pulmonary tuberculosis patients.Methods 80 patients with new smear positive pulmonary tuberculosis were selected as the research subjects.According to the random number table method,they were divided into observation group and control group,40 cases in each group.The control group was treated with 2HRZE/4HR chemotherapy,the observation group was treated with broncho-vaxom tablets based on the treatment of the control group.After 6 months of treatment,the sputum negative conversion rate,pulmonary lesions absorption,the incidence rate of adverse reaction and immune function were compared between the two groups.Results After 2,4,6 months of treatmentt,the sputum negative conversion rates of the observation group were 90.00％,95.00％ and 97.50％,respectively,which were significantly higher than those of the control group(x2 =4.020,4.114,3.914,all P ＜ 0.05).After 2,6 months of treatment,the total effective rates of the observation group were 87.50％ and 97.50％,which were significantly higher than those of the control group (x2 =4.588,5.000,all P ＜ 0.05).After 6 months of treatment,the IgA,IgG,IgM,CD3+,CD4+,CD4+/CD8+ in the observation group were (70.24 ± 6.19) ％,(46.89 ± 6.25) ％,(2.21 ± 0.39),(3.86 ± 1.43) g/L,(14.76 ± 2.58) g/L,(1.47 ± 0.65) g/L,respectively,which were significantly higher than those of the control group(t =-2.116,-2.575,-2.322,-2.138,-4.513,-2.599,all P ＜ 0.05),the CD8+ was (18.85 ± 2.08) ％,which was significantly lower than that in the control group (t =2.609,P ＜ 0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups (x2 =0.251,P ＞ 0.05).Conclusion Short course chemotherapy regimen combined with bronchovaxom can improve the new smear positive pulmonary tuberculosis patients with recent sputum negative conversion rate and lung lesions absorption effect,improve the immune function of patients and without increasing the incidence of adverse reactions,it is worthy of clinical attention.

Objective:To investigate the changes of T-lymphocyte subsets, T-cell immunoglobulin and mucin domain molecule-1 (TIM-1) and TIM-3 levels, and cytokines in the peripheral blood of patients with active tuberculosis.Methods:From December 2017 to December 2018, 50 tuberculosis patients and 50 cured tuberculosis patients in Zhejiang Hospital of Integrated Chinese and Western Medicine were selected as the tuberculosis group and cured tuberculosis group, respectively. Fifty healthy individuals in the same period were selected as the control group. Flow cytometry was used to detect the T-lymphocyte subsets in the peripheral blood. The mRNA levels of TIM-1, TIM-3, interferon(IFN)-γ and interleukin(IL)-4 in peripheral blood mononuclear cells (PBMC) were detected by quantitative real-time polymerase chain reacticn (PCR). T test was used for statistical analysis. Results:The ratio of CD4 + /CD8 + T lymphocytes in the tuberculosis group (1.21±0.50) decreased significantly, comparing with those in the cured tuberculosis group (1.88±0.62) and the control group (1.92±0.82). The differences were statistically significant ( t=2.148 and 2.207, respectively, both P<0.05). The mRNA levels of TIM-1, TIM-3 and IL-4 in PBMC in the tuberculosis group were 2.16±0.37, 1.59±0.36 and 1.52±0.69, respectively, which were all higher than those in the cured tuberculosis group (1.60±1.23, 1.01±0.52 and 0.91±0.36, respectively) and the healthy control group (1.40±0.27, 0.92±0.34 and 0.79±0.42, respectively). All of these differences were statistically significant ( t=14.120, 11.440, 17.130, 12.090, 12.050 and 17.030, respectively, all P<0.05). However, the IFN-γ mRNA level (0.43±0.11) was lower than that in the cured tuberculosis group (1.74±0.72) and the control group (1.82±1.17), and the differences were both statistically significant ( t=13.880 and 11.430, respectively, both P<0.05). Conclusion:The immune dysfunction in patients with active tuberculosis may be related to the low ratio of CD4 + /CD8 + T lymphocytes, the increased expressions of TIM-1 and TIM-3, and the imbalance of helper T lymphocyte (Th)1/Th2 cytokines.

Objective:To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) in tuberculous meningitis (TBM).Methods:From August 1, 2020 to August 31, 2022, 99 patients with suspected TBM admitted to the Tuberculosis Diagnosis and Treatment Center, Hangzhou Chest Hospital, Zhejiang University School of Medicine were enrolled. The cerebrospinal fluid (CSF) was tested for mNGS, GeneXpert Mycobacterium tuberculosis/rifampin (GeneXpert MTB/RIF) and mycobacterium culture. The sensitivity, specificity, positive predictive value, negative predictive value, agreement rate, Kappa value of the diagnostic efficacy of the three test methods were compared.The receiver-operating characteristic (ROC) curve of the diagnostic efficacy of mNGS was drawn. Chi-square test and rank sum test were used for statistical analysis. Results:Among the 99 suspected patients with TBM, 67 were diagnosed with TBM and 32 were non-TBM. Based on the results of 67 cases clinically diagnosed with TBM, the sensitivity, specificity, positive predictive value, negative predictive value, agreement rate and Kappa value of mNGS for the diagnosis of TBM were 82.1%, 100.0%, 100.0%, 72.7%, 87.9% and 0.748, respectively. The sensitivity of mNGS was higher than that of GeneXpert MTB/RIF (50.7%) and mycobacterium culture (28.4%). The differences were statistically significant ( χ2=12.61 and 32.42, respectively, both P<0.01). The detection time of mNGS was 1.0 (1.0, 2.0) day, which was shorter than 42.0 (42.0, 42.0) days of mycobacterium culture with statistical significance ( Z=10.80, P<0.001). ROC curve analysis showed that mNGS had the best diagnostic efficacy when the number of Mycobacterium tuberculosis sequences in CSF was one. Conclusions:The sensitivity and specificity of mNGS in the diagnosis of TBM are high, and the detection time is shorter, which could be used in the early diagnosis of TBM.

Objective: To investigate the efficacy and safety of using pegylated recombinant human granulocyte-colonystimulating factor (PEG-rhG-CSF) in preventing neutropenia in multiple chemotherapy cycles. Methods: A multicenter, prospective, open-label, singlearmstudy was designed. Patients with malignant tumors, such as lung, ovarian, and colorectal cancers, who received multiple cycles of chemotherapy with the prophylactic use of PEG-rhG-CSF for 2-4 consecutive cycles participated in the study. Results: After the prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 4.76% (13/273) in the first cycle to 1.83% (5/273), 1.15% (2/174), and 2.08% (2/96) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 11.36% (31/ 273) in the first cycle to 6.23% (17/273), 2.87% (5/174), and 3.13% (3/96) in subsequent cycles. The incidence of febrile neutropenia (FN) during the first cycle was 0.73% (2/273). The duration of FN was 2 days in one case and 5 days in another case. FN was not observed during the second, third, or fourth cycle. After the secondary prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 25% (7/28) to 3.57% (1/28), 0% (0/28), and 6.67% (1/15) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 71.43% (20/28) to 10.71% (3/28), 14.29% (4/28), and 0% (0/15) in subsequent cycles. The proportion of patients who received antibiotic therapy during the entire chemotherapy period was 10.48% (44/420). Conclusion: The application of PEG-rhG-CSF once per chemotherapy cycle can effectively reduce the occurrence of neutropenia in patients under multiple cycles of chemotherapy treatment with good safety.

Objective     To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods     A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results     A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion     Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.