Objective To investigate whether the mortality and death causes of renal transplant recipients have changed from 1985 to 2002 in our center.Methods 145 cases of renal transplant recipients who died during 1985 to 2002 were divided into 3 groups: 1985 to 1990,1991 to 1996,1997 to 2002. The death causes and the mortality on the 1st ,2nd,3rd,4th and 5th year post transplant of each group were reviewed.Results During the three periods,the 1st,2nd,and 3rd year mortality was decreased. Infection as a cause of death fell from 31.8 % to 29.2 % and 26.7 % . Whereas death from liver disease,cancer and cardiovasvular diseases was increased.Conclusions The mortality is decreased. Infection,cardiovascular diseases,liver diseases and cancer were the main causes of death after transplantation from 1985 to 2002. It is important to prevent these diseases and treat them effectively in order to improve the recipients' survival rate.

Objective To investigate the experiences of combined liver-kidney transplantation (CLKTx).Methods Six patients underwent CLKTx in our center. The primary diseases included chronic glomerulonephritis and post-hepatitis B cirrhosis in 4 patients, hepatitis B virus associated nephritis and primary hepatocellular carcinoma in 1 patient, and polycystic kidney and polycystic liver in 1 patient. Cyclosporine A (or tarcrolimus), mycophenolate mofetil and methylprednisolone were applied to prevent rejection. Four cases of post-hepatitis B cirrhosis received lamivudine. And hepatitis B immunogloblin was given to 4 patients for a short term.Results All 6 liver grafts had good primary function. Five renal grafts had good primary function within one week post-transplantation. One patient with delayed kidney graft function needed supportive hemodialysis. The serum creatinine was declined to normal level 52 days post-operation. Pleural effusion occurred in all 6 patients among which 2 patients needed surgical drainage. Two patients had to be treated for bacterial pneumonia and pneumocystis carinii pneumonia respectively. Three patients needed lipid-lowering therapy at early time post-operation. At the last follow-up, all 6 patients were alive with normal renal graft function and liver graft function. The panel reactive antibody (PRA) of one patient was 23 % before transplantation, and remained at about 8 % post-transplantation. The serum HBsAg and HBV DNA of all 4 post- hepatitis B cirrhosis patients became negative post-transplantation.Conclusion CLTx is a safe procedure for combined hepatic and renal end-stage disease with excellent short-term results.

Objective To investigate the incidence and clinical characteristics of urinary carcinoma in the patients with aristolochic acid nephropathy(AAN)in uremia stage who received maintenance hemodialysis or renal transplantation.Methods The data of 38 AAN patients who had received renal replacement therapy and treated in the authors' service from Mar.2000 to Dec.2006 were reviewed,and the incidence and clinical pathological features of urinary carcinoma in these 38 AAN patients were summarized,in order to look for correlation between the frequency of hemodialysis and the occurrence of carcinoma.Results 15 of the 38 AAN patients received hemodialysis,and the remaining 23 patients underwent renal transplantation.During the follow-up period,seven patients who received hemodialysis were reported to have developed urinary carcinoma,the incidence was 46.7%(7/15),which was significantly higher than the incidence in patients who had undergone renal transplantation(3/23,13.0%;P0.05).Conclusion The prevalence of urinary carcinoma was much lower in the AAN patients who had undergone successful renal transplantation than in those patients who received only maintenance hemodialysis.Renal transplantation may be of a better treatment for the AAN patients in uremia stage.There was no correlation between the frequency of hemodialysis and the incidence of carcinoma.

Objective To explore the application value of Roy adaptation mode in self-image disorder and reformation of patients suffered from breast cancer after operation.Methods 178 cases of postoperative patients suffered from breast cancer were separately divided into the experimental group (90 cases)and the control group(88 cases) at random according to the order of hospital admission.The experimental group adopted nursing of the Roy adaptation mode based upon operation and normal treatment,while the control group received general nursing besides operation and routine treatment.The investigation was carried out using the form of questionnaires.The occurrence rate of self-image disorder,life quality by using GQOLI-74 questionnaire,psychological quality by using emotion scale were compared between the two groups.Results The occurrence rate of the self-image disorder of the patients of the experimental group was evidently lower than that of the control group after the nursing measure was taken.Scores of all items of life quality and emotional scale of the experimental group were evidently higher than those of the control group.Conclusions Applying Roy adaptation mode to nurse post-operative patients suffered from breast cancer is a very good nursing mode,it can facilitate psychological suitability,improve psychological quality and promote their effective adaptability.It has pivotal significance to lower the occurrence rate of the self-image disorder of the patients,reform the self-image and make them return to society early.

Objective To investigate the effects of rapamycin on renal tissue and function of rats with protein overload nephropathy and to explore the protective mechanism of losartan. Methods Experimental rat models with protein overload nephropathy, induced by intraperiotoneal injection of BSA (2. 0 g/d)into female Wistar rats, were divided into three groups: control group, rapamycin group(injected intraperitoneally with rapamycin) and losartan group(injected intraperitoneally with rapamycin and given orally with losartan). At different time points, the quantity of 24-hour urine protein and renal function were measured, and the morphologic changes of renal tissues were evaluated by HE staining and electron microscope. Results Both at day 7 and day 14, rats received BSA developed intense proteinuria. At day 7, compared with control group, 24-hour proteinuria increased markedly in rapamyein group (P<0.05). Nevertheless,proteinufia was notably alleviated in losartan group (P<0.05). At day 14, 24-hour-urine protein of rapamycin group was also significantly higher than that of the losartan group (P<0.05), but therewas no significant difference between control group and losartan group (P>0.05). Proteinuria and intratubular albumin cast formation were alleviated notably in losartan group. The fusion of focal podocytes in rapamycin group was obvious in comparison with control group. Conclusions Rapamycin can agrravate proteinuria in rats with protein overload nephropathy through changing the barrier of glomerular filtration by damaging podocytes. Furthermore, losartan can alleviate severe proteinuria induced by rapamycin.

Objective X-linked adrenoleukodystrophy (X-ALD) is a genetically determined disorder that is characterized by demyelination of central nervous system,and impaired adrenal cortex and abnormal accumulation of very long chain fatty acids in body fluid and tissue.The clinical manifestation,biochemical change,and magnetic resonance imaging were analyzed.Methods Clinical data of 11 cases with X-ALD were summarized and analyzed,including symptoms,signs,and inspection result.Relevant literature was reviewed.Results All cases were males,whose average onset age was (7.2 ± 4.7) year-old.It was (2.4 ± 1.9) years that the mean interval appears from onset to diagnosis.Six cases were with onset of adrenal insufficiency (AI),remaining 5 onset neural symptoms,where plasma very-long-chain fatty acids (VLCFA) was tested in 6 patients,all with abnormally high levels and brain magnetic resonance imaging(MRI) showed demyelination of cerebral white matter in 9 ones.Conclusions ALD is a X-linked genetically determined disorder that mainly affects the nervous system and adrenal gland.Plasma VLCFA test,ALD gene test,and cerebral MRI are reliable diagnostic methods.Early diagnosis and appropriate therapy would improve survival and neurological outcomes.

Objective To explore the factors related to the delayed graft function (DGF). Methods Clinical data of 150 recipients were collected and performed by Cox proportional hazards regression analysis . In addition, the glutathione S-transferase (GST) gene polymorphism of 172 donors and 157 healthy persons was analyzed by multiple PCR and SSP-PCR. Results DGF was observed in 24 patients among 150 recipients. Pretranplantation dialysis mode, PR A levels and recipient gender were uncorrelated with the incidence of DGF(P>0. 05). Urinary volume of the second 24 hours after transplantation was an independent predictor of DGF(RR=1. 002, P = 0. 001). The frequency of donor's null GSTM1 in DGF group was significantly higher than that in non-DGF group(P<0. 05). Conclusions Urinary volume of the second 24 hours after transplantation could be a predictor for DGF. The null GSTM1 in donor might be one of the factors related to the EGF.

Objective To establish a universal stem loop primer (USLP) based real-time PCR method to scan mature miR profile and quantify it's expression.Methods The common universal stem-loop primer pairs were re-designed; 8 random nucleotides were introduced at 3 ' end for reverse transcription of the mature miR,establishing a miR scanning and quantifying system based on SYBR Green Ⅰ PCR (improved USLP method).10-fold gradient diluted standard miRNA-155 cDNA ( 1 ～ 109 copies/μ1) were utilized to evaluate the sensitivity of this method.The specificity was verified by melting curve assay; the precision was assessed by intra-assay coefficient of variation (ICV) of threshold cycle (Ct value) through 20 repeated detections of the standard miR-155 cDNA (2 × 105,2 × 106,2 × 107 copies/μl) ; cost of the primers and time were evaluated,compared with that of the conventional USLP method.Peripheral blood samples were cultured with phytohaemagglutinin (PHA) for0 h,16 h,24 h,48 h and 72 h,and 87 candidate miR that may be associated with human immunity from PubMed data were scanned and quantified from the cultured T cells.Results The sensitivity of the improved USLP method was 103 copies/μl of standard miR-155 cDNA.Melting curve assay showed a single melting peak at 80 ℃,suggesting the excellent PCR specificity of miR-155.Precision of our method quantifying miR-155 was acceptable (ICV ＜ 2.5％ ).Compared with the traditional stem loop primers,our method saved 75％ cost of primers ( 1 917 bp vs 7 851 bp) and 60％ test time of reverse transcription (85 min vs 205 min).By our method,85 of the 87 miR expression in T cells had no significant difference after the PHA stimulation; the expression of miR-150 (72 h) decreased by 10 times and that of miR-155 (48 h) increased 8 times after culture with PHA (Z =-2.032,P =0.042;Z =- 2.023,P =0.043,respectively ).Conclusions The improved USLP method is fast,precise,sensitive,and cost-effective.It could be used for miR profile scanning and quantifying in T cells.

Objective To investigate the protective effect of hydrodynamics-based injection with plasmids of IL-10, TGF-β1 and TGF-β1 + IL-10 in murine skin transplantation model. Methods Plasmids were constructed by inserting coding sequences of IL-10 and TGF-β1. In F1 mice (Balb/c×C57BL/6, H-2b/d) to Balb/c (H-2d) murine skin transplant model, 20 μg plasmid (blank or IL-10 or TGF-β1 or IL-10 + TGF-β1) was injected to donors by hydrodynamics-based method in first day and every interval 2 days for 6 times. The survival of grafts was observed after 7 days of transplantation. After C56BL/6 spleen cells transfused Balb/c accepted 5 times hydrodynamics-based injection as above,CD4+ CD25+ T regulatory cells of spleen were measured by FACS. Results The survival time of graft in each group was (13.50±1.04)days (blank group), (13.83±1.16)days (IL-10 group), (15.33±1.50) days (TGF-β1 group), and (21.33±3.20) days (IL-10 + TGF-β1 group),respectively (P<0.05). The percentage of CD4+ CD25+ cells was (6. 58±1.86)% (blank group),(10.52±1.13)% (IL-10 group),(14.44±0.42)% (TGF-β1 group),and (14.25±1.24)% (IL-10+TGF-β1 group) respectively (P<0.05). Conclusion Hydrodynamics-based transfection of IL-10 combined with TGF-β1 can synergistically enhance the percentage of CD4+ CD25+ T cells and prolong the graft survival.

Objective To develop the hypothesis ‘saturated or non-saturated cytotoxicity model' and explain the various phenomena of antibody mediated immunoresponses in recipients,including rejection and accommodation.Methods The imitating complement dependent cytotoxicity.The threshold set to identify as saturated or non-saturated cytotoxicity depends on antigen-antibody complex(R)whether or not above lethal number(D)in effective time.Feasibility of the hypothesis was examined through explaining various phenomena mediated by anti-donor antibodies,especially some contradictory phenomena.Results Hyperacute rejection,accelerated rejection and acute rejection could be well explained by saturated cytotoxicity.Accommodation of ABO imcompatible transplantion,de novo antibody induced injury,change of protein profile,and C4d deposition in graft could be well elucidated by the hypothesis.Conclusion The hypothesis saturated or nonsaturated cytotoxicity model' help to interpret and interconnect various phenomena of antibodies mediated immune response,such as rejection and accommodation.