Objective To observe the effects and safety of rapamycin (Rap) in combination with cyclosporine A (CsA) and steroid (Pred) as triple regimen for prevention of acute rejection after renal transplantation.Methods Fifty patients with de novo cadaveric kidney allograft were randomized into two groups. In the study group there were 30 patients treated with Rap, CsA, and Pred, while in the control group there were 20 patients with conventional triple therapy of azathioprine (Aza), CsA, and Pred. Same dosages of CsA and Pred were used in both groups. Any adverse event after treatment was observed and recorded in detail. The laboratory investigations were checked and analyzed periodically.Results The pre-protocol population included 26 patients in study group and 18 patients in control group. The 2-year patient and graft survival rates in both groups were 100 %. The incidence of acute rejection was 3.7 % (1/27) in study group, 25 % (5/20) in control group, respectively. All episodes of acute rejection were reversed by methylprednisolone. The trough levels of CsA kept same in both groups, but CsA dose in study group was lower than that in control group. Blood concentrations of total cholesterol and triglyceride in study group were higher than those in control group. Conclusion Rap is an effective and safe immunosuppressive drug for prevention of acute rejection after renal transplantation. Rap combined with CsA allows reducing the dose of CsA. But its main side effect is hyperlipidemia.

Objective To analyse the research status and research focus in immune thrombocytopenia.Methods The literatures of ITP subject category in the SCI-expanded (SCI-E) database during 2006-2016 were retrieved.Then the co-authorship,time distribution,research regional distribution,institute distribution,keywords distribution,especially the international hot research focus in ITP,were analyzed by using the Cite Space software base on the bibliometrics method.Results A total of 963 journal articles were retrieved,and the quantity of articles about ITP subjective category showed a steady increasing trend during 2006-2015.The researches mainly distributed in the east Asia,Europe and north America areas,and top issuing countries were American,China,Japan,Canada and England.The top issuing institution was the Cornell University.The anima model,thrombopoietin receptor agonist,Helicobacter pylori eradication,systematic review and T lymphocyte proliferation were the research hot points;the high frequency key words such as large dose of dexamethasone,gene polymorphism,correlation and reaction were the latest study direction.Conclusion The co-authorship,regional distribution,research hot points and trend are determined,which can provide references for ITP scientific field of our country.

Objective To study the injury mechanism, diagnosis and therapy of traumatic dislocation of the peroneal tendons. Methods 18 cases with traumatic dislocation of the peroneal tendons were operated in our institute from 1986 to 2000. The mechanism of injury and clinical findings were investigated. 2 cases with acute dislocation were operated by suturing the peroneal retinaculum directly. 16 cases with recurrent dislocation were treated with Watson-Jones operation. Results 10 cases with recurrent dislocation were follow-up from 1 year to 15 years with an average of 6.2 years. Only one recurrence due to ankle sprain was found and the other 9 cases had no more dislocation and returned to sports without symptom.Conclusion Traumatic dislocation of the peroneal tendons can be caused by the injury of ankle joint in three positions:dorsiflexsion and eversion, dorsiflexsion and inversion, plantflexsion and inversion. Anti-resistant test of dorsiflexsion and eversion may help diagnosis. Watson-Jones operation has the advantages of simple to apply, minor trauma and sound clinical outcome.

Objective To summarize the clinical data of renal transplants survived with graft function more than 10 years and the adverse events during this period, and to discuss the main strategies for the long-term survival Methods Survival rate of renal transplants simultaneously survived with graft function > 10 years and grafts was counted respectively in total 1003 renal transplant recipients at our hospital before Dec. 31,1998 retrospectively. Their relevant survival,adverse events and initial post-operative immunosuppressive regimens were recorded simultaneously.Results As of Dec. 31, 2008, the 10-year survival rate of recipients was 62. 7% (629/1003), and recipients with graft function accounted for 85. 37 % (537/629). Of them, 94. 75 % (596/629) recipients received cyclosporine A (CsA) -based immunosuppression plus other antiproliferative immunosuppressive agents. Post-transplantation adverse events included coronary heart diseases in 57 cases (9. 06 %), liver damage in 32 cases (5. 09 %), malignancy in 29 cases (4. 61% ), diabetic mellitus in 25 cases (3. 97 %), apoplexy in 16 cases (2. 54 %), severe bone marrow depression in 14 cases (2. 23 %), femur head necrosis in 7 cases (1.11%), lower-extremity thrombosis in 3 cases (0. 48 %), sudden deafness in 2 cases (0. 32 %). There were 690 survival patients and 49 deaths including 19 (38. 78 %) due to cardiocerebral vascular accidents, 10 (20. 41%) due to malignancy, 9 (18. 37 %) due to hepatic failure, 4 (8. 16 %) due to infection, 3 (6. 12 %) due to treatment abandonment, 2 (4. 08 %) unknown reasons and 2 (4. 08 %) accidental deaths. Conclusion Long-term survival after renal transplantation is associated with the primary medication of CsA as the main immunosuppressive regimen. The non-immunologic factors such as the prevention and cure of cardioeerebral vascular diseases and the early finding of liver functional abnormality and tumor are the main points focused during follow-up.

OBJECTIVETo investigate the clinical efficacy of Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for lumbar spinal stenosis of type Fengshi Bizu (Chinese characters).

METHODSSince February 2012 to February 2013, 120 patients with lumbar spinal stenosis of Fengshi Bizu (Chinese characters) syndrome were retrospectively studied. According to different treatment methods, 120 patients with lumbar spinal stenosis were divided into Panlongqi tablet (Chinese characters)group and control groups, respectively. In Panlongqi tablet (Chinese characters)group, 60 patients were treated by Panlongqi tablet (Chinese characters) combined with lumbar facet joints release solution including 26 males and 34 females with an average age of (60.40±3.36) years old ranging from 46 to 65 ; the course of the disease was 2 to 15 years (averaged 7.6 years). In control group the other 60 patients were treated with lumbar facet joint release including 24 males and 36 females with an average age of (61.20±2.47) years old ranging from 48 to 63; the course was 3 to 14 years (averaged 6.9 years). The clinical effect of patients were evaluated by JOA and ODI score before treatment, at 4 weeks and 3 months after treatment.

RESULTSAll patients were followed up for 4 to 7 months (means 5.6 months). After 3 months,7 cases in control group recurrenced symptoms,only 1 case in Panlongqi tablet (Chinese characters) group recurrenced. At 4 weeks and 3 months of follow-up, ODI score and JOA score of Panlongqi tablet group were much better than those of the control group.

CONCLUSIONFor lumbar spinal stenosis of type Fengshi Bizu (Chinese characters),which were treated with lumbar facet joint release with Panlongqi tablet(Chinese characters), supplemented by back muscle exercise, in relieving waist and low back pain symptoms and improving functional status of lower lumbar spine, can obtain satisfactory clinical outcome, is a good method of conservative treatment for such diseases.

Aged ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Exercise Therapy ; Female ; Humans ; Lumbosacral Region ; physiopathology ; Male ; Middle Aged ; Punctures ; Retrospective Studies ; Spinal Stenosis ; drug therapy ; physiopathology ; therapy

Objective　To study the effects of measures for preventing early postburn damage in improving survival rate of burn patients during the third stage. Methods　12 568 burn cases admitted to our institute were chronically divided into three groups (1958-1980;1981-1990;1991-2000). Total burn surface area (TBSA), survival rate, incidence of burn shock, systemic infection and organ damage as well as the main treatments adopted in the recent decade were retrospectively analyzed. Results　Incidence of burn shock, systemic infection and organ damage were significantly lower, and the total survival rate and the survival rate in patients with different TBSA were markedly higher in the third group as compared with those in the first and the second group. Incidence of organ damage in patients treated with delayed fast fluid infusion, early escharectomy en masse, early enteral feeding, early prevention of inhalation injury and gut bacterial translocation were also significantly lower than in the control. Conclusion Measures taken in the third group for preventing early postburn damage play an important role in improving the survival rate of burn patients.

Objective:To investigate the effects of thalidomide on vascular endothelial growth factor(VEGF) and quality of life in patients with primary hepatocellular carcinoma after transcatheter arterial chemoembotization.Methods:A total of 60 patients with HCC,who were treated with transcatheter arterial chemoembolization (TACE) in Affiliated Hospital of Chengde Medical University from January 2014 to January 2016,were randomly divided into group A (n=30)and group B (n=30).Group A was treated with Thalidomide in combination with TACE,oral 200 mg every night for 1 month;group B was treated with TACE alone.The levels of VEGF in the two groups were detected before treatment and 3 weeks after treatment;the quality of life of patients before treatment and 1 month after treatment was evaluated by quality of life scale (QOL);the weight of two groups before and after treatment and adverse reactions during treatment were compared.Results:There was no significant difference in VEGF levels between the two groups before treatment (P＞0.05).After treatment,the levels of VEGF in the two groups were higher than those before treatment,and the VEGF levels in the group A was significantly lower than that in the group B,the difference was statistically significant (P＜0.01).There was no significant difference in QOL score and body weight between the two groups before treatment (P＞0.05).The QOL scores of the two groups after treatment were lower than those before treatment,but the QOL scores of patients in group A were significantly higher than those in group B (P＜0.05).There was no significant difference in weight between the two groups before and after treatment (P＞0.05).In group A,1 patients (3.33％) had severe somnolence,2 (6.67％) patients stopped taking thalidomide due to severe dry mouth,and the remaining 27 patients were able to tolerate.Conclusion:Thalidomide combined with TACE in the treatment of patients with HCC can reduce the levels of VEGF and improve the quality of life of cancer patients,which is worthy to be popularized in clinic.

AIM: To explore the mechanism and significance of the intestinal epithelial cellular membrane damage following burn serum. METHODS: The intestinal epithelial cell(IEC-6) were cultured. The changes of total membranous phospholipid contents fluidity of the IEC membrane were dynamically examined with fluorescence polarization technique and HPCE. RESULTS: In the early stage after stimulation by 20% burn serum, the membranous fluidity obviously decreased. The total phospholipid contents decreased, the content of PLA 2 markedly increased. CONCLUSION: The serial changes in IEC after burned could result in the damages of IEC membrane structure, the integrity of cell membrane and function.

Objective To review the cadaveric kidney transplantations at our center in the past 22 years and to analyze the causes and the influencing factors on death in 176 patients who died after renal transplantation. Methods A total of 1 039 patients received cadaveric kidney graftings between October 1977 and June 1999.Patient's mortality was calculated by the Kaplan Meier method.The factors which might lead to patients' death,including age and sex of the donors and recipients,frequency of transplantation,dialysis time and transfusion volume before transplantation,cold ischemic time (CIT),delayed graft fuction (DGF),rejection,immunosuppressive regimen,and post transplant complications,were analyzed by log rank and Cox model. Results Total mortalities of the patient at 1 ,5 ,10 ,and 15 year were 6.9%,19.7%,32.1%,and 34.7%,respectively.The leading causes of patients' death were infection,cardiocerebral vascular diseases,and hepatic failure.The factors of transplant times,dialysis time before transplant,immunosuppressive regimen,chronic rejection,post transplant complications of pneumonitis and cardiocerebral vascular diseases were significant impact on transplant patient death by the analysis of Cox model. Conclusions In this series of 1039 cadaveric kidney transplant patients,the mortality since the first year after transplantation was increased annually by 2.5% during the past 22 years.The leading causes of patients' death are infection,cardiocerebral vascular diseases,and hepatic failure after renal transplantation.Transplant times in which patients receive the procedures,dialysis time before transplant,immunosuppressive regimen,chronic rejection,post transplant complications of pneumonitis and cardiocerebral vascular diseases are significant factors impacting on transplant patients' death.

Objective To investigate the effects and mechanisms of immunosuppressants on in- duction of apoptosis of peripheral T lymphocytes.Methods T lymphocytes were derived from healthy donors and activated by super antigen SEB.The rest or activated T lymphocytes were incubated with immunosuppressants such as myophenolate mofetil (MMF),cyclosporine A (CsA),FK506,azathio- prine (Aza),sirolimus (SRL),prednisone (Pred),and daclizumab (Dac,anti-CD25mAb),alone or combined,for 3 days.The incidence of apoptosis was determined by the methods of confocal microsco- py,flow cytometer,DNA-ladder fragmentation electrophoresis,and reverse transcription-polymerase chain reaction (RT-PCR) gene amplification profiles.The quantitive assay of IL-2 and Fas in the cul- ture medium was also performed using the enzyme linked immunosorbent assay kit.Results Apoptosis in rest T lymphocytes was just induced by Pred among various immunosuppressants.MMF,Aza,and Pred promoted apoptosis in activated T lymphocytes (P＜0.05,P＜0.01),but it was blocked by CsA,FK506,SRL,and Dac (P＜0.01).After adding two or three kinds of immunosuppressants, the incidence of apoptosis in activated T lymphocytes was apparently lower than in control group (P＜0.01).The expression of Fas and IL-2 by activated T lymphocytes was inhibited by FK506 and CsA (P＜0.05).Conclusion MMF,Aza,and Pred may induce apoptosis of activated T lymphocytes via the signal pathway of Fas/Fasl.CsA and FK506 could inhibit the apoptosis of activated T lymphocytes by blocking the production of IL-2.Also,SRL and Dac can block the apoptosis of activated T lympho- cyte by interfering with the effect of IL-2 on T lymphocytes activation process.