Composite tissue allotransplantation is a new option in reconstruction surgery,but the immunological rejection is accepted as an public medical problem after surgery.As the number of composite tissue allotransplantation increases,postoperative immunosuppression becomes the new hot.This article will illustrate and summarize the progess of postoperative immunesuppression.

Objective:To investigate the value of serum miR-214-5p level in predicting acute kidney injury(AKI)after cardiac surgery in children.Methods:From January 2015 to December 2019, 102 children with congenital heart disease underwent extracorporeal circulation in Haikou Maternal and Child Health Hospital were selected.The children were divided into AKI group( n=28)and non-AKI group( n=74). The levels of serum miR-214-5p, serum creatinine(Scr), cystatin C(Cys-C)and kidney injury molecule-1(KIM-1)were measured three hours after operation in both groups.Multivariate logistic regression was used to analyze the risk factors of AKI after cardiac surgery in children.The values of miR-214-5p, Scr, Cys-C and KIM-1 levels in predicting AKI in children after cardiac surgery were analyzed by receiver operating characteristic(ROC)curve. Results:The levels of serum miR-214-5p[(3.14±1.36)vs.(0.95±0.47)], Scr[(490.35±93.62)μmol/L vs.(108.26±22.40)μmol/L], Cys-C [(3.27±0.85)mg/L vs.(0.86±0.24)mg/L] and KIM-1 [(26.83±8.70)μg/L vs.(6.42±1.18)μg/L] in AKI group were significantly higher than those in non-AKI group(all P<0.05). Multivariate logistic regression analysis showed that serum miR-214-5p, Scr, Cys-C and KIM-1 levels were independent risk factors for AKI in children after cardiac surgery( OR=2.518, P<0.001; OR=1.630, P=0.035; OR=1.974, P<0.001; OR=2.902, P<0.001). ROC curve analysis showed that the area under the curve(0.958, 95% CI: 0.905-0.996)of miR-214-5p, Scr, Cys-C and KIM-1 combined prediction of AKI were the largest, and its sensitivity and specificity were 98.5% and 86.3%, respectively. Conclusion:The level of serum miR-214-5p is significantly higher in children with AKI after cardiac surgery, which is an independent risk factor for AKI after cardiac surgery, and the combination of Scr, Cys-C and KIM-1 levels can better predict the occurrence of AKI.

Objective Excision repair cross-complementing gene-1(ERCC1) are key regulatory enzymes whose expression patterns are associated with overall survival(OS) in several malignancies.Their expression patterns and prognostic value in resected gastric adenocarcinoma(GAC) are not known and need to investigate.Methods A total of 109 patients who underwent resection for GAC in Liu′an People′s Hospital from January 2010 to June 2013 had tissue available for analysis.The primary objective was to assess for the differential expression of ERCC1 using by immunohistochemistry.The secondary objective was to assess for the association between OS and the expression of ERCC1.Results The median follow-up was 21.2 months,and the median OS was 28.8 months.Resected GAC exhibited differential expression of ERCC1(high expression,n=25(23%)).ERCC1 expression was not associated with OS(18.9 months vs.27.7 months,P=0.72).In a subset analysis of patients who received chemotherapy(n=73),high ERCC1 expression was associated with decreased OS(16.7 months vs.53.8 months,P=0.03).After controlling for known adverse pathologic features,high ERCC1 expression persisted as a negative prognostic factor in multivariate Cox regression analysis(HR=2.22,95% CI1.05-4.98,P<0.05).Conversely,in patients who underwent resection only(n=35),high ERCC1 expression demonstrated a trend toward improved OS(40.4 months vs.12.7 months,P=0.10).A positive prognostic influence also was present on multivariate analysis(HR=0.20,95% CI0.05-0.84,P=0.03).Conclusion Resected GAC exhibited differential expression of ERCC1.Among all patients,ERCC1 expression levels were not associated with OS.High ERCC1 tumor expression is associated with decreased OS in the patients who received chemotherapy but is associated with increased OS in those who underwent surgery alone.ERCC1 expression have prognostic value in resected gastric cancer,and further investigation is needed.

Objective:To investigate the clinical effect of ozone combined with sodium hyaluronate injection in the treatment of knee osteoarthritis and its effect on inflammatory factors and hemorheology in patients.Methods:146 patients with knee osteoarthritis who received treatment in our hospital from October 2016 to February 2019 were selected and divided into observation group and control group according to the random number table method, 73 cases in each group.In the experimental group, intra-articular injection of sodium hyaluronate combined with ozone was used, while in the control group, glucosamine hydrochloride tablets were routinely taken and intra-articular injection of sodium hyaluronate was performed. Patients in both groups were treated once a week for 5 consecutive weeks for a course of treatment. General data of patients in the two groups were analyzed, and the efficacy, visual analogue scale (VAS) score and hospital for special surgery knee score (HSS) before and after treatment, levels of inflammatory factors and changes in hemorheology indexes were compared between the two groups.Results:There was no significant difference in general data between the two groups ( P>0.05). Before treatment, there was no significant difference in VAS score and HSS score between the two groups ( P>0.05). After treatment, VAS score and HSS score in the two groups were significantly decreased and increased respectively ( P<0.05). Compared with the control group, VAS score was significantly decreased and HSS score was significantly increased in the observation group after treatment ( P<0.05). The total effective rate in the observation group was higher than that in the control group, and the difference between the two groups was statistically significant ( P<0.05). Before treatment, there was no significant difference in the levels of inflammatory factors vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF-α), interleukin (IL)-1β, IL-6, hypersensitive C-reactive protein (hs-CRP) and matrix metalloproteinase (MMP)-13 in the articular fluid between the two groups ( P>0.05). After treatment, the above indexs in the observation group were significantly lower than those in the control group ( P<0.05). After treatment, the levels of inflammatory cytokines in the articular fluid of the two groups were lower than before ( P<0.05). There was no significant difference in hemorheology indexes between the two groups before treatment ( P>0.05), and the two groups were significantly improved after treatment, and the degree of improvement in the observation group was significantly better than that in the control group ( P<0.05). Conclusions:Ozone combined with sodium hyaluronate intra-articular injection is more effective in the treatment of knee osteoarthritis, which can effectively reduce the level of inflammatory factors and inflammatory response, improve hemorheology, and then reduce the pain of patients, improve the knee joint function.

Objective To investigate the changes of serum Copeptin and matrix metalloproteinase-9 (MMP-9) in children with chronic heart failure (CHF) and its clinical significance. Methods A total of 186 children with CHF were selected for CHF group, including 78 cases of cardiac function grade Ⅱ, 65 cases of grade Ⅲ, and 43 cases of grade Ⅳ. There were 57 cases of dilated cardiomyopathy, 68 cases of congenital heart disease and 61 cases of other diseases. Another 85 healthy children from health checkup were chosen as controls. The levels of serum Copeptin and MMP-9 were determined by enzyme linked immunosorbent assay (ELISA), and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was measured by bidirectional lateral flow immunoassay. The left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular ejection fraction (LVEF), and left ventricular short fraction shortening (LVFS) were measured by echocardiography. ROC curve was used to analyze the diagnostic value of serum Copeptin and MMP-9 in CHF. The correlation of serum Copeptin and MMP-9 with the cardiac function indices were examined by Pearson correlation analysis. Results The levels of serum copeptin, MMP-9, and NT-proBNP in different cardiac function groups (Ⅱ, Ⅲ, Ⅳ) increased gradually with the aggravation of the cardiac function damage and were higher than those in control group, and the differences were statistically significant (P<0.05). Compared with the control group and cardiac function grade Ⅱ group, the levels of LVESD and LVEDD were increased and the levels of LVEF and LVFS were decreased in the grade Ⅲ and Ⅳ groups. Compared with the grade Ⅲ group, the levels of LVESD and LVEDD were increased and the levels of LVEF and LVFS were decreased in the grade Ⅳ groups. There were significant differences (P<0.05). The ROC curve showed that the area under the curve (AUC) and 95％ CI of serum Copeptin, MMP-9, NT-proBNP and combinations of these three biomarkers in the diagnosis of CHF were 0.845 (0.781～0.914), 0.806 (0.736～0.883), 0.894 (0.828～0.962) and 0.925 (0.846～0.983) respectively, and the optimal thresholds were 12.5 pmol/L, 175.3 μg/L and 2037.0ng/L. The level of serum Copeptin was positively correlated with MMP-9 (r=0.807, P<0.001). Conclusion Serum Copeptin and MMP-9 may be involved in the ventricular remodeling in CHF children and they are expected to be a good indicator for the diagnosis of CHF and cardiac function.

Objective: To establish a treatment protocol for severe blepharoptosis. This protocol helps to achieve better accuracy and more stable result. Methods: Evaluate levator muscle function pre-operatively. When levator function ≤ 1 mm, frontalis suspension technique was performed. When levator function more than 1 mm, technique of levator resection, combining excision of tarsus and levator, and tarsus-levator-CFS suspension was performed accordingly until it reaches adequate correction result during the surgery. Results: A total of 275 severe ptosis patients was included from January 2015 to June 2016. 52 cases (388 eyes) received levator resection. 162 cases received combining excision of tarsus and levator. 24 cases received tarsus-levator- CFS suspension. 37 cases received frontalis suspension. 326 eyes achieved adequate correction results. 62 cases were still undercorrected. The asymmetry result showed that 76 cases presented good symmetry. 142 cases presented moderate asymmetry and 57 showed severe asymmetry. Conclusions The new treatment protocol shows a satisfactory result with better accuracy and more stable correction for severe ptosis correction.