Objective To explore the key points of the diagnosis and treatment of severe pneumonia following renal transplantation in the elderly. Methods The clinical data of 28 patients with severe pneumonia following renal transplantation were retrospectively analyzed, including 20 cases aged <60 years (<60 years old group) and 8 cases aged ≥60 years (≥60 years old group). Results In <60 years old group, the severe pneumonia occurred during 1-13 months after the renal transplantation. All the patients had fever. 10 cases coughed and 8 cases had expectoration. 6 cases had type I respiratory failure (RF) and 3 cases experienced type 11 RF. 6 cases had lobar pneumonia and 13 cases occurred interstitial pneumonia. One case experienced lung consolidation. The pathogens of 16 cases in <60 years old group were identified, including 4 cases with bacterial pneumonia, 4 cases with cytomegalovirus (CMV) pneumonia, 2 cases with pneumocystis carinii pneumonia, Ⅰ case with mycoplasma infection, Ⅰ case with tuberculosis infection, and 4 cases with mixed infection (2 cases infected by bacteria plus CMV, 1 case by bacteria plus fungi and 1 case by bacteria plus tuberculosis). Combined drugs (broad-spectrum antibiotic, antivirus and antifungal agent) were administered on the initial stage and sensitive drugs were used later according to the pathogens. Hormone or immunoglobulin was used when other drugs were useless. 17 cases were cured and 3 cases died. In ≥60 years old group, the severe pneumonia occurred during 1-9 months after renal transplantation. All 8 patients had fever, too. 5 cases coughed and 3 cases had expectoration. 3 cases experienced type ⅠRF and 1 case experienced type Ⅱ RF. 3 cases had lobar pneumonia and 5 casesoccurred interstitial pneumonia. The pathogens of 5 eases were identified. Among them, 2 cases were affected by bacterial pneumonia, 1 case by CMV pneumonia and 2 cases by mixed pneumonia (one by bacteria plus CMV, one by bacteria plus fungi). Similar modality was applied, and 5 cases were cured and 3 cases died. Conclusions Most of severe pneumonia occur during 1-9 months after renal transplantation in the elderly. The main pathogens are bacteria and CMV. Medications for all of the most common pathogens and assisted ventilation should be used early. Specific narrow-spectrum antibiotic or antiviral drugs could be used quickly after pathogens were identified, and hormone or immunoglobulin could be administered to patients when the infection is severe or the pathogens are uncertain.

Objective To understand current situation of surgery grading management in 22 hospitals from Beijing Municipal Administration of Hospitals,and to discuss the problems and to make suggestions for better application and management.Methods Based on general survey,Surgery of Grading Conditions of All Municipal Hospitals was issued to 22 municipal hospitals to make related staff fill related data.Results Except for 3 specialty hospitals,19 hospitals have launched the surgery grading management,while they are in different steps of implementing hierarchical directory,surgeon permission and dynamic management.These hospitals have different reference standards of making hierarchical directory.84.2％ hospitals give surgeons authorities according to levels of operations evaluated by professional title,surgery grade and doctors' technical skills.There are 14 hospitals applying information management on surgery grading.Conclusion Uniform criteria of hierarchical directory,extension of surgeon permission system and implementation of surgery grading information management will contribute to regulation fulfillment.

Objective To study the whole genome DNA methylation changes induced by low dose radiation (LDR) in mouse,and mRNA expression profiles of DNMT1 and MBD2 in peripheral blood mononuclear cell (PBMC) and tissues.Methods Thirty male BALB/c mice were randomly divided into 3 groups:control,single exposure (0.5 Gy),and fractionated exposure of 6 MV X-rays for 10 d (0.05 Gy/d × 10 d).Control mice were sham-treated.To determine the immediate (early) effect of irradiation,15 mice (5/group) were sacrificed 2 h after the last irradiation.The other 15 mice were sacrificed 1 month after the last irradiation (delayed effect).Before sacrifice,blood was sampled immediately.Kidney,liver,spleen,brain and lung tissues were collected.A global DNA methylation quantification Kit and highperformance liquid chromatography (HPLC) were used to investigate the methylation level in blood DNA.The expressions of DNMT1 and MBD2 were determined by RT-PCR.Results For the early effects of irradiation,as compared with controls,fractionated exposure to X-ray irradiation led to the significant depression of global DNA methylation level in blood (t =10.19 and 8.93,P ＜ 0.05).DNMT1 and MBD2 mRNA were down-regulated in PBMC,kidney and liver (t =5.06,3.01,3.97,12.25,3.50 and 3.73,P ＜0.05),and MBD2 was also down-regulated in spleen (t =3.03,P ＜ 0.05).However,no changes were observed in single exposed group.As for the delayed effects,the methylation levels of blood were not changed in the single or fractionated exposed groups,and only MBD2 mRNA was down-regulated in PBMC and brain of fractionated exposed group (t =3.52 and 2.85,P ＜ 0.05).Conclusions Fractionated LDR exposure can induce genome DNA hypomethylation,which is tissue-specific,and may be related with down-regulation of DNMT1 and MBD2.

Objective To detect the levels of the mRNA expression of TIM-3,TIM-1,T-bet,GATA-3,IFN-γ,IL-4 and Galectin-9 in the peripheral blood monocytes (PBMCs) of the patients with Graves disease(GD),and to explore their potential role in the pathogenesis of GD.Methods We used fluorescence quantitative real-time reverse transcription-polymerase chain reaction to measure the mRNA expression of TIM-3,TIM-1 and other associated genes in PBMCs of 70 patients with GD and 22 healthy controls.In addition,we analyzed the relationship of TIM-3,TIM-1 and other associated genes.Results The expression of TIM-3 and TIM-1 mRNA in the PBMCs from GD patients were abnormally higher,the GD patients with Graves' ophthalmopathy group had significantly higher level of TIM-3 mRNA expression than that of GD patients without Graves' ophthalmopathy group,but no statistically significant difference was found in the expression of TIM-1 mRNA.Untreated GD patients had significantly higher level of TIM-3 mRNA expression than that of GD patients in recurrence group,however the expression of TIM-1 mRAN was opposite.But no statistically significant difference was found in TIM-3 mRNA expression of recovery GD patient and healthy control group.Though the expression of TIM-1 mRNA was significantly decreased,it was still higher than that of the normal control group.Conclusion TIM-3 and TIM-1 may participate in the occurrence,development and turnover of GD.TIM-3 or TIM-1 may prove to be an important target for developing new drugs and treatments to GD.

Objective To evaluate the clinical application value of anti-β2 glycoprotein I ( anti-β2 GPI) and anti-cardiolipin antibodies ( ACA ) in the patients with antiphospholipid syndrome ( APS).Methods Serum levels of anti-β2GPI(IgG) and ACA(IgA, IgG, IgM) were determined by enzyme linked immunosorbent assay ( ELISA ) in 53 patients with APS , 27 patients with SLE accompanied by APS , 55 patients with simple SLE , 46 patients with other autoimmune diseases and 40 healthy controls.The sensitivity and specificity of anti-β2 GPI and ACA for the diagnosis of APS and the correlation of serum anti-β2 GPI and ACA-IgG levels were analyzed.The cases were identified in the Affiliated Hospital of Qingdao University during 2012.1 to 2014.2 and the data were analyzed with χ2 test, Mann-Whitney U test and Spearman correlation.Results The positive rates and serum levels of anti-β2 GPI, ACA-IgG/M, ACA-IgG, ACA-IgM were significantly higher in the APS group [77.4%(41/53), 81.1%(43/53), 56.6%(30/53), 52.8%(28/53);14.1 AU/ml, 19.6 U/ml, 17.9 U/ml] than those in the simple SLE group [16.4%(9/55), 32.7%(18/55), 20.0%(11/55), 18.2%(10/55); 4.9 AU/ml, 9.4 U/ml, 8.7 U/ml, χ2 =40.4, 25.7, 15.4, 14.2;U=255.0, 632.5, 476.5, P<0.01], other autoimmune diseases group[0%(0/46), 4.3%(2/46), 2.2%(1/46), 2.2%(1/46); 3.2 AU/ml, 2.6 U/ml, 3.4 U/ml, χ2 =60.7, 58.6, 33.9, 30.5;U=53.5, 87.0, 66.0, P<0.01] and healthy controls [0%(0/40), 2.5%(1/40), 0%(0/40), 2.5%(1/40);3.0 AU/ml, 3.5 U/ml, 2.9 U/ml, χ2 =55.3, 56.5, 33.4, 26.9;U=61.0, 124.0, 152.0, P <0.01 ] separately.The positive rate and serum level of ACA-IgA in the APS group [18.9%(10/53), 11.7 U/ml] were significantly higher than that in the other autoimmune disease group [2.2%(1/46), 2.9 U/ml,χ2 =6.9, U=581.0, P<0.01] and healthy controls[2.5%(1/40),2.1 U/ml,χ2 =4.4,U=764.0,P<0.05] separately.The specificity of anti-β2 GPI (83.6%) for APS diagnosis was significantly higher than that of ACA (67.3%, χ2 =4.0,P<0.05).Conclusions anti-β2 GPI, ACA-IgG and ACA-IgM, have higher clinical application value in the APS diagnosis and identification of SLE with or without APS than ACA-IgA.The specificity of anti-β2 GPI for APS diagnosis is higher than that of ACA.

Objective To investigate the role of RANKL/RANK/OPG system in bone metabolism of ankylosing spondylitis (AS) by detecting bone mineral density, bone metabolism factors such as osteoprotegerin (OPG), soluble receptor activator of nuclear factors-κB ligand (sRANKL) and the expression of membrane-bound (mb) RANKL in the peripheral blood T lymphocytes. Methods Bone mineral density of AS patients were measured by dual-energy X-ray absorptiometry (DEXA) and serum levels of OPG, sRANKL,tartrate resistant acid phosphatase 5b (TRACP-5b) and bone alkaline phosphatase (BALP) were determined by enzyme-linked immunosorbent assay (ELISA). The percentages of CD4+/RANKL+ and CD8+/RANKL+ in the peripheral blood were detected with flow cytometry. T-test, x2-test were used for statisical analysis. Results ① The incidence of osteopenia and osteoporosis in AS was 47% and 37% respectively. ② Serum RANKL,TRACP-5b levels and RANKL/OPG ratio were higher in AS patients than those in normal controls (P<0.05).But there was no significant difference in OPG and BALP between AS patients and normal controls. ③There were positive linear correlation between serum levels of RANKL and OPG, sRANKL and TRACP-5b, OPG and TRACP-5b in AS (P<0.01). ④ The prevalence of CD4+/RANKL+ cells in the peripheral blood of AS patients was significantly higher than that in the normal controls (P<0.05). Conclusion There is a high incidence of bone loss in AS patients. Increased bone resorbtion is the feature of bone metabolism in AS.RANKL/RANK/OPG system may play an important role. The imbalance of RANKL/RANK/OPG system may be one of the bone loss mechanisms of AS. CD4 + T lymphocyte may play an important role in osteoclasts differentiation and bone resorption in AS by up-regulating the expression of RANKL.

Objective To investigate the relationship between the gene polymorphism of TLR3c.1377,TLR9-1486,and TLR9 2848 and susceptibility to multiple sclerosis(MS)in Han people of south China. Methods A total of 123 unrelated MS patients from South China with a clinical or laboratory definition MS according to 2005 Revisions to the McDonald Criteria were studied. Another 126 controls were randomly selected from hospital staff of non-autoimmune diseases and healthy individuals. Toll like receptor (TLR) 3 and TLR 9 genotypes were determined by PCR and digested by specific restriction enzymes.Results There was significant difference in genotype and allele distribution of TLR3c.1377 polymorphism between the MS patients and the controls (P<0.05), and the MS patients with T allele had a lower risk (OR=0.532, P=0.014). There was no significant difference in genotypes and allele distribution of TLR9-1486 polymorphism between the MS patients and the controls. There was higher TLR9 2848 A allele frequency in the MS patients than in the controls ((39.8%) vs. 30.6%;P=0.037), and higher risk in MS patients with A allele than those without ((OR=)(1.837), P=0.020). There was no significant interaction among the TLR3c.1377, TLR9-1486 and TLR9 2848 allele. Strong linkage disequilibrium was found between TLR9-1486 and TLR9 2848, but there was no significant interaction between the polymorphism of TLR9-1486 and TLR9 2848 in the MS patients.Conclusion TLR3c.1377 and TLR9 2848 polymorphisms may be related to MS in Han people in south China. TLR3c.1377 and TLR9 2848 may be linked with susceptibility genes.

BACKGROUND: The renal transplanted recipients were in poor immunosuppressive state. Compared to common person, the bladder transitional carcinoma in recipients was aggressive and easy to recurrence. Looking for a more effective therapy method to decrease the recurrence of recipients' bladder transitional carcinoma is the hot and difficult problem in clinical study.OBJECTIVE: To analyze the efficacy and safety of submucosal injection epirubicin following transurethral resection of bladder tumor (TUR-Bt) to treat the recurrence of bladder transitional cell carcinoma in renal transplantation recipients.METHODS: Totally 9 renal transplantation recipients with transitional cell carcinoma of bladder were retrospectively studied. The patients' periods without cancer, the frequency of recurrence within one year, the rates of side effect, the changes of tumor grading following recurrence and allograff function were recorded when the routine method and submucosal injection epirubicin following TUR-Bt were used in different period respectively.RESULTS AND CONCLUSION: Submucosal injection epirubicin following transurethral resection of bladder tumor was safe and effective to treat bladder transitional cell carcinoma recurrence in renal transplantation recipients. Compared to the routine perfusion, periods without cancer and the frequency of recurrence within 1 year were significantly decreased, which can elevate recipients life quality and long-term survival rates.

Objective:To investigate the effect of controlled low central venous pressure (CLCVP) combined with hepatic blood occlusion on blood loss and hemodynamics in hepatectomy. Methods:Sixty hepatocellular carcinoma patients with American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ undergoing hepatectomy were randomly divided into two groups. One was the group of hepatic blood occlusion (group I);the other was the group of CLCVP combined with hepatic blood occlusion (group II). During the parenchy-mal transection phase of surgery, 60.05). Likewise, no significant difference was noted in MAP and HR at different time points of the two groups (P>0.05). The CVP in groupⅡwas significantly lower than that in groupⅠat the beginning of and 20 min after the paren-chymal transection phase of the surgery. Conclusion:CLCVP combined with hepatic blood occlusion can reduce blood loss effectively during hepatectomy.

BACKGROUND: Documents recorded that the correlation between micro emulsion Ciclosporin peak concentration (C_2) and area under curve was best with maximum individual difference. According to C_2, dose of Ciclosporin can be adjusted indMdually to decrease acute rejection and Ciclosporin toxicity, which has widely used in perioperative stage of renal transplanted recipients. However, some transplantation center still used tough concentration (C_0) to adjust the dose of Ciclosporin in stable stage of renal transplanted recipients. OBJECTIVE: To analyze the efficacy and safety of changing from monitoring C_0 to C_2 in stable stage recipients following renal transplantation. METHODS: Totally 65 patients with renal transplantation were enrolled in this study, including 31 males and 34 females, aged 20-57 (39.4±15.3) years. Within 3 months prior to this study, all patients did not suffered from rejection, and their serum creatinine and urea nitrogen were stable (creatinine ≤180 μmol/L). They were in stable stage after renal transplantation. Their period of transplantation and function of allograft were recorded. Their C_0 and C_2 of Ciclosporin were assayed. According to the target C_2 value 500-600 μg/L, the patients were prospectively and randomly divided into 3 groups. In the high C_2 group (n=17), the dose of Ciclosporin was decreased. In the target C_2 group (n=23), the dose of Ciclosporin was remained. In the low C_2 group (n=25), the dose of Ciclosporin was increased. All of the patients were followed-up for 12 months. The grafts function and the complications of heart, lung and brain were compared. RESULTS AND CONCLUSION: According to the target concentration of Ciclosporin C_2, the dose of Ciclosporin in the high C_2 group was decreased by 575.0 mg. The Creatinine and urea nitrogen of 88% patients were stable, while blood pressure, blood fat and blood uric acid decreased in parts of patients. In the target C_2 group, the levels of creatinine, urea nitrogen, Co and C_2 of patients were stable, no complications of heart, lung and brain occurred. According to the target concentration of Ciclosporin C_2, the dose of Ciclosporin in low C_2 group was increased by 755.0 mg. The creatinine and urea nitrogen of 84% patients were stable. All of the patients were no complications of heart, lung and brain. It is safe and effective to adjust Ciclospori dose under C_2 monitoring according to the target peak concentration (500-600 μg/L) in most stable stage recipients following renal transplantation.