Objective:To summarize the curative effect in treatment of Raynaud's syndrome with chemical thoracic sympathectomy(CTS) guided by X-ray since 2001.Methods: From March 2001 to August 2007,97 patients with Raynaud's syndrome(186 limbs) were treated by CTS.Guided by X-ray,a needle was punctured through the back skin to the second thoracic sympathetic ganglion beside the thoracic vertebrae and 2 mL of 5%(v/v) phenol was injected.Results: The first CTS treatment produced a good effect on 146 limbs with an effective rate of 78.5%(146/186).The same treatment was performed on the limbs with no effect 1-2 days after the first treatment and produced good effect on 13 limbs with an effective rate of 32.5%(13/40).The total effective rate of the patients who were hospitalized for the first time was 85.5%(159/186).Of the 97 patients,78 patients(80.4%) were followed up for 47 months on an average with an effective rate of 69.5%.And the rate of complications was 11.4% for pheumothorax,and 3.9% for hydrothorax.Hyperalgesia on axillary region and anterior chest wall;Horner syndrome and sinus bradycardia were rare.Conclusion: CTS is minimally invasive and effective in treatment of Raynaud's syndrome.

Objective To investigate the expression of nestin in keloid and hypertrophic scarring.Methods Samples were obtained from patients with normal skin(n=8),flat scars(n=7),keloids(n=8) and hypertrophic scars(n=8),respectively.Immunohistochemistry staining was used to measure the nestin expression in above samples.Nestin positive cells were counted to evaluate the expression levels.Results ①Nestin expression was detected in basal cells,prickle cells,sweat glands,hair follicles,sebaceous glands,and vascular endothelial cells in 8 samples of normal skin,and in fibroblasts in 7 of them.Nestin was also positively expressed in abovementioned cells or skin appendages in samples of flat scars,keloids and hypertrophic scars.②Nestin positive cell counts(epidermic cells,fibroblasts,and vascular endothelial cells) in keloids and hypertrophic scars were significantly higher than those in normal skin and flat scars(P0.05).Conclusions The increased expression of nestin in epidermic cells,fibroblasts,and vascular endothelial cells in keloid and hypertrophic scarring supports a possible role of nestin as fibrosis inducing factors in keloids and hypertrophic scars.

ObjectiveTo compare the clinical effectiveness and adverse effects following low doses versus traditional doses of amphotericin B liposome (L-AmB) in the treatment of patients with invasive pulmonary fungal infections (IPFI) after renal transplantation.MethodsA total of 26 postrenal transplantation patients with IPFI between Jan. 2005 and Mar. 2011in Zhujiang hospital received L-AmB treatment identified low doses group (0.2-0.5 mg·kg-1·d-1,n =19) or traditional doses group (1-5 mg· kg-1,d-1,n =7) were reviewed.ResultsThe treatment duration in low doses group and traditional doses group was 20.3 +12.7 and19.3 ±13.2 days respectively (P＞0.05).The effective rate in low doses group and traditional doses group was 84.2％ and 57.1％ respectively (P＞0.05).The overall dosage was significantly less in the low doses group (414.7 ± 241.7 mg) than in the traditional doses group (1158.8 ± 928.0 mg) (P＜0.05).The incidence of adverse effect was significantly lower in the low doses group than in the traditional doses group (21.1％ vs.85.7％,P＜0.05).ConclusionThe effectiveness of low doses of L-AmB protocol in the treatment of IPFI postrenal transplantation patients was similar to that of traditional doses of L-AmB protocol,but the incidence of adverse effects in low doses of L-AmB protocol was significantly lower.

Objective To investigate the effect of C4d deposition in peritubular capillary (PTC)in chronic allograft nephropathy (CAN) on prognosis and intervention of renal transplantation recipients. Methods All the cases who received the renal graft biopsy due to diagnosis of CAN from January 2000 to August 2008, and had the 2-year follow-up data were included in the study. The clinical data were analyzed according to the C4d deposition in PTC. Results Among 86 cases 39 cases were C4d positive (C4d+ group) and the remaining 47 cases were negative (C4d group). There was no significant difference in sex, age, donor source, transplant times, time after biopsy, the panel reactive antibodies (PRA) level between two groups (P＞0. 05). Before intervention, there was no significant difference in serum creatinine (Scr) and 24 h urinary protein between two groups (P＞0. 05). At the end of 2-year followed-up period, graft loss rate and urinary protein levels in C4d+group were significantly higher than in C4d- group (P＜0. 05). Before intervention, the incidence of blood lipid disorder and hypertension was higher in C4d- group (P ＜ 0. 05 ), but no significant difference was found in uric acid and blood sugar levels (P＞0. 05). At the end of 2-year followed-up period, there was no significant difference in blood glucose, uric acid, blood pressure and lipid profile (eliminating renal lost cases) between two groups (P＞0. 05). Conclusion The patients with CAN and C4d+ means the involvement of chronic humoral rejection and have poor clinical results. Effective intervention against humoral immune response can improve renal allograft survival.

Objective To evaluate the clinical safety and efficacy of focused ultrasound body contouring apparatus in abdominal fat reduction and body contouring.Methods Forty healthy subjeets were equally randomized into treatment group and control group,and received two treatments with the JCS-01 device (3H Medical Technology Co,Ltd,Beijing,China) in the abdominal region at one-week interval.During each treatment,the subject was placed on the treatment bed and the region of interest was spread with an acoustic coupling medium.Then the ultrasonic transducer was fixed,and the operator controlled the computerized system to move the bed in a designed regon.The control group would not receive any energy therapy during treatment time.Subjects were followed for 28 days after the last treatment (day 35).Abdominal circumference,regional photos and safety parameters were recorded at the time instantly before and after treatment and days 14 and 35.Subject satisfaction survey was conducted at day 35.Results One subject in control group was loss of follow-up.No local skin reactions,such as erythema edema or papules,and no changes with clinical significance in laboratory examinations occurred in all other 39 subjects.The proportion of subjects with over 0.5 cm abdominal circumference reduction in the treatment group was significantly higher than the control group at all time points (P＜0.05).Peak abdominal circumference reduction was on day 35.The abdominal circumferences of 19/20 subjects in the treatment group were reduced by 0.83-6.33 cm,and the mean abdominal circumference was reduced by 3.09 cm on day 35.The total effective rate was 95 ％,and the subject satisfactory rate was 75 ％.Conclusions The focused ultrasound treatments for body contouring is safe and tolerable and also significantly reduces abdominal circumference.

AIM: To establish a simple, rapid and accurate high performance liquid chromatographic method (HPLC) for the determination of cyclosporin A (CsA) in human whole blood, and to study the influence of nicotinylmethylamide (Nic) on the pharmacokinetic parameters of cyclosporin A (CsA). METHODS: Whole blood CsA concentrations were measured by HPLC in 18 healthy volunteers administrated single CsA or co administrated Nic. The data of time blood concentrations of CsA were analyzed by 3p97 Program. The analysis of variance and two one sided t test were used to compare the main pharmacokinetic parameters of CsA in the two administrations. RESULTS: C max and AUC 0～∞ of CsA had statistically significance between the single CsA group and co administration of Nic group (P0.05). CONCLUSION: This HPLC method is simple, sensitive and accurate, and is suitable for routine determination of blood CsA levels in human. Nic can improve the absorption of CsA and increase the C max and AUC of CsA, but has no influence on the metabolism of CsA.

Objective To investigate the implication of nonspecific cellular infiltrates in biopsy of chronic allograft nephropathy and the prognosis.Methods Recipients indicated to renal biopsyproven CAN were analyzed from June 2007 to June 2009 retrospectively,and classified into three groups according to the Banff 2009 criteria:chronic active T-cell-mediated rejection (CTMR),chronic active antibody-mediated rejection (CAMR),interstitial fibrosis and tubular atrophy not otherwise specified (NOS).All the cases were followed up for 2 years.CD4,CD8,CD20 and CD3 expression,and C4d deposits were investigated.Results Eighty-three cases were enrolled in the study,diagnosed as having CTMR in 34 cases (40.9％),CAMR in 12 cases (14.6％),and NOS in 37 cases (44.5％).There was significant difference in total interstitial inflammation (ti),peritubular capillaritis (ptc) and C4d deposition among CTMR,CAMR and NOS groups.The number of CD4+ and CD8+ in CTMR group was increased as compared with CAMR and NOS groups.The 2-yeard renal graft survival in CTMR,NOS and CAMR groups was 73.5％,78.4％ and 41.7％ respectively.The prognosis in CAMR group was worst.Conclusion CAMR predicated a worse graft survival.Infiltration of CD4+ and CD8 + cells may help to make the diagnosis of CTMR.

Objective To study the effect of Alemtuzumab on acute rejection (AR) and graft survival after kidney transplantation.Method Published domestic and foreign literatures regarding the effects of Alemtuzumab used on acute rejection and graft survival were reviewed,and Meta analysis was employed to analyze the Results.Odds ratio (OR) and its 95％ confidence interval (95％ CI) were used as the parameters to evaluate the therapeutic effects.The statistical analyses were performed with RevMan 5.1 software.Result A total of 9 pertinent research articles were reviewed.Meta-analysis of pooled results indicated that Alemtuzumab prevented the recipients of kidney transplantation from acute rejection effectively with half year prevention of OR 0.37 and 95％ CI 0.24-0.58 (P＜0.01),one year prevention of OR 0.43 and 95 ％ CI 0.29-0.64 (P＜0.01),and two year prevention of OR 0.69 and 95％ CI 0.47-1.02 (P ＜ 0.01),respectively.It was revealed that Alemtuzumab could reduce the incidence of acute rejection by 55％ in half year,51％ in one year and 28％ in two years,respectively.No statistically significant difference in graft survival was found between Alemtuzumab group and control group (OR =1.18,95％ CI 0.76-1.85,P =0.46).No statistically significant difference in patients' survival was found between Alemtuzumab group and control group (OR =0.94,95 ％ CI 0.52-1.72,P =0.85).Conclusion Alemtuzumab may effectively prevent the recipients of kidney transplantation from acute rejection,but not obviously influence the graft and patient survival.

BACKGROUND:The rate of tuberculosis infection was high in patients after renal transplantation. Clinical manifestation is not typical, which brings inconvenience to diagnose.
OBJECTIVE:To summarize the diagnosis and therapeutic methods of tuberculosis infection after al ograft renal transplantation.
METHODS:Relevant diagnosis and therapeutic method of 13 patients with tuberculosis infection after renal transplantation were retrospectively analyzed in the Department of Organ Transplantation, Zhujiang Hospital of Southern Medical University from January 2010 to October 2013.
RESULTS AND CONCLUSION:The onset time was 4-120 months after operation;62%(8/13) patients within 18 months after transplantation. Patients affected long-period fever, mainly low-grade fever. Four cases were identified according to the history, imaging data in combination with positive pathogenic diagnosis. Five cases were identified according to the history, imaging data combined with lung biopsy histopathology. The remaining four cases were identified according to the history, imaging data with experimental effective anti tuberculosis treatment. Early pulmonary symptom was not obvious. Chest CT was helpful in early diagnosis and differential diagnosis. Al patients fol owed early, law, ful , right amount, combined with principles of anti-tuberculosis treatment, and treatment usual y lasted for 6-10 months. They were given combined anti-tuberculosis infection drugs, adjustment of immunosuppressive agents and five-ester capsule for liver protection therapy. Thirteen patients were alive, no deaths. Two cases with early infection without timely treatment suffered from acute rejection, leading to loss of graft function and returned to hemodialysis. The others were cured and left hospital. Renal function was normal after 6-month fol ow-up (serum creatinine). Results indicated that after renal transplantation, patients with pulmonary tuberculosis should be early detected, early diagnosed and early treated. CT guided biopsy can be used as an effective and feasible means for diagnosis and identification of smear negative pulmonary tuberculosis after renal transplantation. Adjustment of immune scheme, anti-tuberculosis treatment and five-ester capsule significantly reduced calcineurin inhibitor dose, and lessened their adverse reactions.

BACKGROUND: Pneumocystis carinii pneumonia(PCP)is a severe and life-threatening complication in renal transplantation patients.It is associated with high mortality,occult onset and rapid progression,so the clinicians who care organ transplant patients need in-depth study and understanding the law of occurrence,development and therapy of the disease to achieve the better outcome.OBJECTIVE: To retrospective analyze the etiopathogenisis,clinical characteristics,diagnosis,as well as the prognoses of PCP in renal transplant recipients.METHODS: A total of 36 patients who suffered complication of PCP after renal transplantation in the Organ Transplantation Center,Zhujiang Hospital,were retrospective analyzed.The general information of cases,clinical manifestation,therapeutic regimen,and prognoses were analyzed.The diagnosis and intervention measures were summarized.RESULTS AND CONCLUSION: Among 36 patients,22 were male and 14 were female.Three patients died of complicated acute respiratory distress syndrome,the rest were cured with good renal graft functions.Among 36 PCP patients,31 cases were occurred within 6 months,and 5 in 7-18 months.Pneumocystis carinfiwas examined in bronchoalveloar lavage fluid or lung tissues of 15 cases(41.7%),which was not be checked out in the other 21 cases.Most of patients were cured and the transplanted renal function was well after reducing immunosuppressive agent doses,administrating compound sulfamethoxazole and supportive treatment.The findings demonstrated that PCP common occurred with 6 months after renal transplantation,with typical clinical symptom but indiscoverable pathogen.Its early stage diagnosis was based on clinical history,symptom,and image examination.Among organ transplantation cases,PCP is a severe opportunistic infection,but with early diagnosis and proper treatment the prognosis remains good.