Objective To investigate the efficacy and safety of anti CD25 Ab (Zenapax;Daclizumab) induction therapy in 62 patients following renal transplantation. Methods Sixty-two renal transplant recipients treated with Daclizumab induction therapy were analyzed retrospectively from Sep. 1999 to May 2004. Main immunosuppressive therapy regimen consisted of steroids cyclosporine and mycophenolate mofetil in all recipients after operation. According to Daclizumab dosage, these recipients were divided into 1-dose group, 2-dose group and over 2-dose group. All patients received Daclizumab 1 h before operation.Results The patients subject to Daclizumab were followed up from 3 months to 57 months. Seven of them had acute rejection ( 11.3 %) at intervals for 10.3 months, from 2 months to 14 months. Patient who had acute rejection at 10th month after operation lost his graft at 13th month after transplantation for graft dysfunction. The incidence of acute rejection was 15.6 % among 45 patients followed up over 12 months. Conclusions Induction therapy of Daclizumab could decrease the incidence of acure rejection, delay the time of acute rejection and relieve the severity of rejection. More graft can be long-survival. We can lower the dosage of CsA effectively and safely after induction of Daclizumab.

Objective To compare the graft function of 2 methods of kidney harvesting,the modified method of combined liver and kidney procurement and rapid en bloc kidney procurement. Methods The clinical data of 220 cadaveric renal transplantation recipients were collected(12 months follow-up),174 cases from en bloc kidney procurement and 46 from combined liver and kidney procurement.The average harvesting time,the incidence of renal vein injury,1 year kidney survival and incidence of acute rejection were compared between the two methods.Results In average harvesting time and incidence of renal vein injury,the en bloc kidney procurement were better than the method of combined liver and kidney procurement.However,the method of combined liver and kidney procurement was better than the en bloc kidney procurement in 1 year kidney survival,1 year incidence of acute rejection and average warm ischemia time.There was no difference in 1 year survival of patients and 24 h,1 week and 1 year graft function after transplantation. Conclusion Although the method of combined liver and kidney procurement is better than the en bloc kidney procurement in 1 year kidney survival and 1 year incidence of acute rejection,there is no difference between the 2 methods in 1 year survival of patients and graft function after transplantation.

Objective:To study the relationships of portal hypertensions to vasoactive substances-angiotensin(AT-Ⅱ)in cirrhosis patients.Methods:48 patients with liver cirrhosis(LC)(including 18 patients with compensated LC and 30 patients with decompensated LC) and 32 normal controls(NC) were studied. Color duplex doppler ultrasonography was used to study portal venous and splenic venous blood flow(PVBF and SVBF).Also,the blood concentration of AT-Ⅱ was detected.Then,analyze the correlation between PVBF and SVBF to AT-Ⅱ.Results:Portal hyperdynamic exists in cirrhosis patients from beginning to the end. Low level of AT-Ⅱ in compensated LC patient has no relation with portal hyperdynamic, high level of AT-Ⅱ in decompensated LC has positive relation with portal hyperdynamic.Conclusion:This study has directed significance of clinical treatment and diagnosis.

China ; Critical Care ; history ; methods ; trends ; History, 20th Century ; History, 21st Century ; Humans

Objective To evaluate the effects of positive end-expiratory pressure (PEEP) targeting optimal oxygenation on local gas distribution and inflammation in dogs with acute respiratory distress syndrome (ARDS). Methods ARDS was induced by saline alveoli-lavage and oleic acid intravenous. The animals were mechanical ventilated 4 h at optimal PEEP titrated by oxygenation. Computed tomography (CT) scans were performed before and after induction of ARDS and at the end the study. NF-κB was measured by electrophoretic mobility shift assay (EMSA), IL-6 and IL-10 were assessed by ELISA.Myeloperoxidase (MPO) and malondialdehyde (MDA) were measured. Pathological changes were examined under optical microscope. Results (1) Compared to baseline, total lung volumes decreased and nonaerated areas increased significantly after the induction of ARDS in both groups (P ＜ 0.05 ). Compared with ARDS models, PEEP titrated to achieve optimal oxygenation resulted in greater lung recruitment but was accompanied with hyperinflation, hyperinflation occurred in non-dependent lung. Compared with oleic acidinjured ARDS, the changing of hyperinflated lung areas was increased markedly in saline lavage-injured ARDS (P＜0.05). (2) Compared with right lung ventral lower lobe, lung injury score was lower in right lung upper lobe. Histological injury in right lung dorsal lower lobe was severer than that in right lung upper lobe and right lung ventral lower lobe. NF-κB activation of right lung dorsal lower lobe was markedly higher than right lung upper lobe (P ＜ 0.05 ). MPO and MDA were much higher with right lung dorsal lower lobe than right lung upper lobe and right lung ventral lower lobe ( P ＜ 0.05 ). Compared with right lung upper lobe and right lung ventral lower lobe, IL-6 and IL-10 increased markedly in right lung dorsal lower lobe ( P ＜ 0.05 ). Conclusions Alveolar hyperinflation and aggravated lung injury in non-dependent region were occurred at PEEP targeting optimal oxygenation. Hyperinflation was more common in saline lavage-injured ARDS.

Objective To determine the relationship between the viral load of cerebrospinal fluid (CSF) and sensorineural hearing loss (SNHL) in newborns with symptomatic congenital cytomegalovirus (CMV) infection.Methods The study cohort comprised 36 newborns with symptomatic congenital CMV infection.CSF from all of the patients were analyzed for the presence of CMV DNA by PCR.Audiological function were performed on them by brain stem auditory evoked potential at birth,at 6 and 12 months of age.Results (1)Of the 36 newborns,15 cases (41.7％) had positive CSF PCR result,17 cases (47.2％) had SNHL.(2) The prevalence of SNHL in the group of newborns with positive CSF PCR result was 60.0％ (9/15),and it was 38.1％ (8/21) in the group of newborns with negative CSF PCR result,there was no significant difference of the prevalence of SNHL between the two groups (P =0.194).(3) In newborns with positive CSF PCR result,the amounts of CSF CMV DNA was not different between the newborns with SNHL and normal hearing (3.35 ± 0.68 vs.3.17 ± 0.56,P =0.36).Conclusion A positive CSF PCR result and the CMV viral load of CSF did not correlate with SNHL.

Objective To find out the risk factors of early pulmonary infections after renal transplantatioa Methods The data were collected from 96 patients receiving renal transplantation between Oct. 2006 and Oct 2010, including 48 cases of early lung infection after renal transplantation as infection group, and 48 patients receiving immunosuppressive regimen at the same period as-control group. Taking the factors of lung infecition as variables, t test or chi-square test was used in univariate analyses whereas logistic regression was used in multivariate analyses. Results Single factor analysis showed that induction therapy, albumin levels, dose of steroid in 1 month after operation,family income and prophylactic SMZ treatment were related to lung infectioa Analysis of multiple variables logistic regression revealed that induction therapy, albumin levels, dose of steroid in 1 month after operation and prophylactic SMZ treatment were related to lung infection. Conclusion The correlation analysis indicated that induction therapy and dose of steroid in 1 month after operation have positive correlations with pulmonary infection, while albumin levels and prophylactic SMZ treatment have negative correlations with pulmonary infection.

Objective To investigate the activation of nuclear factor-κB(NF-κB),which was stimulated by angiotensin-Ⅱ(AngⅡ)through classical pathway in human pulmonary microvascular endothehal cells(HPMEC).Method The experiment was divided into two groups:in Ang Ⅱ group,HPMECS were incubated with 10-6mol/L AngⅡ for 0,0.5,1,2 and 4 hours,respectively;in losartan group,HPMEC was pretreated with 10-6mol/L losartan(inhibitor of AngⅡ type 1 receptor)for 1 hour,and then stimulated with 10-6mol/L AngⅡ for 2 hours,and the nucleax protein and the cell plasma protein were prepared by lysis and centrifugation.Electrophoretic mobility shift assay(EMSA)was used to detect the NF-κB DNA binding activity.The inhibitor of κBa(IκBα)was detected by Western blotting.The data were expressed as(x±s)and analyzed with one way analysis of variance.A P value less than 0.05 indicated significant difference.Results Compared with the activity of NF-κB at 0 h (100.0±25.1)after AngⅡstimalation,the activity increased significantly at 0.5 hour(144.5±16.1,P＜0.05),and reached peak value at 2 hours(270.1±27.2,P＜0.05).The concentration of IκBα at 0 hours was 44.4%±2.1%,decreased markedly at 0.5 hours(38.9%±3.6%,P＜0.05),and to the lowest level at 2hours(32.6%±2.3%,P＜0.05).The activity of NF-κB(115.4±10.7)and the concentration of IκBα(43.6%±3.7%)in losartan group had ilo significant difference with AngⅡ group at 0 h(P＞0.05).The activity of NF-κB and the concentration of IκBα in losartan group had significant difference with AngⅡ group at 2hours.Conclusions NF-κB can be activated through classical pathway,which stimulated by AngⅡ in HPMEC.

Objective To investigate the changes in circulatory and pulmonary monary angiotensinⅡin rats with acite lung injury(ALI)and explore the role of angiotensinⅡin ALI.Method Thirty S-D rats were randomly divided into control group(n=6)and ALI group(n=24).The ALI group was further divided into four subgroups of observation at various intervals,3,6,9 and 12 hours after administration of lipopolysaccharide (LPS)into the femoral vein(each n=6).The indices rate,blood gas analysis,wet weight/dry weight(W/D)ratio of lung lobes,and pathological changes were successively observed at 3,6,9,and 12 hours after injury.The content of angiotensinⅡin lung tissue and blood plasma were detected at above set intervals by radioimmunoassay.Data of these assays were analyzed by one-factor analysis of variance.Results Compare with the control group,pH and PaO2 of arterial blood in ALI group decreased significantly(P＜0.05)at all intervals and PaCO2 of arterial blood in ALI group decreased significanfly(P＜0.05).at all intervals and PaCO2 of arterial blood and lung W/D weight ratio increased significantly(P＜0.05),and scores of lung histopathology denoted the lung injuried(P＜0.01).After injury of lung,angiotensin Ⅱ content increased markedly in lung homogenate and blood plasma (P＜0.05).Angiotensin Ⅱ content in blood plasma reached peak value at 9 hours,and content of angiotensin Ⅱ in lung homogenates kept on increasing at allintervals of observation.Conclusions A large amount of angiotensin Ⅱ releases into lung tissue and blood plasma during ALI,suggesting systemic and pulmonary rennin-angiotensin systems are activated.

ObjectiveTo assess the efficacy of subglottic secretion drainage for preventing ventilatorassociated pneumonia.MethodsData of relevant randomized controlled trials (RCT) from January 1991 to June 2010 were collected,and data were split into two groups,namely draining group and non-draining group.Meta analysis of ventilator-associated pneumonia was carried out for finding the incidence and mortality in patients with mechanical ventilation using the methods recommended by the Cochrane Collaboration.ResultsSeven RCTs met the inclusion criteria and 1647 patients were enrolled.Subglottic secretion drainage reduced the incidence of ventilator-associated pneumonia ( OR =0.45,95％ confidence interval [CI]:0.32 - 0.63 ),primarily by reducing early-onset pneumonia.But the mortalities of ventilator associated pneumonia were not significantly different between the two groups ( OR =1.03,95％ confi dence interval [CI]:0.75 - 1.41 ).ConclusionsSubglottic secretion drainage appeared effective in preventing ventilator associated pneumonia among patients expected to require ＞48 hours of mechanical ventilation,but the mortality was unchanged.