Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.

Objective To compare the difference of clinical and laboratory characteristics between the patients undergoing uninephrectomy for urologic diseases and healthy living kidney donors.Methods The change of blood pressure,renal function,blood routine examination,urine protein,plasma electrolytes and blood fat in two groups preoperatively and at one week,one month,6 months and one year postoperatively were retrospectively assessed.Of the 65 living kidney donors,12 were male and 53 were female.Among 354 cases of uninephrectomy for urologic diseases,there were 291 cases of hpper urinary tract tumor,56 cases of hydronephrosis and 7 cases of severe kidney injury.Results Compared to the preoperative status,there was significant difference of hemoglobin,creatinine,urea nitrogen and urine protein in two groups.Clinical and laboratory characteristics of two groups became stable at one months postoperatively,and could reach the preoperative level at 6 months or one year postoperatively.But the creatinine was 25.71%higher than the preoperative level in healthy donors and 25.49%in patients undergoing uninephrectomy for urologic diseases.There was no significant difference between the two groups at one year postoperatively.Conclusions Two groups are safety after nephrectomy.There is no significant difference of clinical and laboratory characteristics between the 2 groups.Strict donor selection,appropriate pretransplantation evaluation,careful operation and postoperative health consulting play important roles in donors;safety and health.

Objective To discuss the diagnosis and treatment of invasive aspergillosis(IA)of lung after kidney transplantation. Methods Ten cases of IA infection of lung after kidney transplantation from January 1999 to May 2006 were reviewed.Among 10 cases.all had been examined by FOB and 3 positive.Six cases had a typical sign of IA in chest CT.Five cases had GM positive. Results Eight cases were cured including 3 cases with itraconazole,5 with amphotericin B.The other 2 died of infection. Conclusions Invasive pulmonary aspergillosis is a severe complication of renal transplantation.Early diagnosis and proper treatment can reduce the mortality.

Objective To establish a post?treatment prognostic score model for newly diagnosed metastatic nasopharyngeal carcinoma, and to investigate the feasibility of stratified therapy. Methods A total of 263 eligible patients with newly diagnosed metastatic nasopharyngeal carcinoma from 2002 to 2010 were enrolled as subjects. The primary tumor was treated with conventional radiotherapy, three?dimensional conformal radiotherapy, or intensity?modulated radiotherapy, and radiation areas included nasopharyngeal tumor and cervical lymphatic drainage region. The metastatic bone tumor was mainly treated with conventional external radiotherapy, while the metastatic liver or lung tumor was mainly treated with surgical resection, radiotherapy, or radiofrequency ablation. The first?line therapy for most of patients was cisplatin?based combination chemotherapy. Factors including the general characteristics, tumor status, and therapy for patients were involved in multivariate analysis, and a prognostic model was established based on the n value (HR=en ) of the prognostic factors. Results The factors influencing the overall survival (OS) in patients were a Karnofsky performance score (KPS) not higher than 70(P= 0?? 00), multiple organ metastases (P=0?? 00), combination with liver metastasis (P= 0?? 00), a number of metastases not less than 2(P= 0?? 00), a level of lactate dehydrogenase (LDH) higher than 245 IU/ L (P= 0?? 00), a number of chemotherapy cycles ranging between 1 and 3( P= 0?? 00), a poor response for metastatic tumor ( stable disease or progressive disease)(P= 0?? 00), and primary tumor not treated with radiotherapy (P= 0?? 01). Based on the prognostic score, patients were divided into low?risk group (0?1?? 5 points), intermediate?risk group (2?? 0?6?? 5 points), and high?risk group (≥7?? 0 points), and the 5?year OS rates in the three groups were 59?? 0%, 25?? 1%, and 0%, respectively. Conclusions The prognostic score model based on the KPS, serum level of LDH, multiple organ metastases, combination with liver metastasis, and number of metastases can effectively predict the survival in patients. Active treatment including at least 4 chemotherapy cycles and radiotherapy for primary tumor can prolong the survival time of patients in the low?and intermediate?risk groups. However, patients in the high?risk group were mainly treated with palliative radiotherapy due to no improvement in the survival by radiotherapy for primary tumor.

Objective To compare the long-term efficacy between two radiochemotherapy regimens for locally advanced nasopharyngeal carcinoma (NPC):intensity-modulated radiotherapy with concurrent chemotherapy (CCRT) versus neoadjuvant chemotherapy (NACT) followed by CCRT.Methods A retrospective analysis was performed on the clinical data of 278 patients with locally advanced NPC who were admitted to our hospital from 2001 to 2008.Of the 278 patients,133 received CCRT,and 145 received NACT followed by CCRT (NACT + CCRT).Results The follow-up rate was 96.6％.The 5-year overall survival (OS),distant metastasis-free survival (DMFS),recurrence-free survival (RFS),and progression-free survival (PFS) were 78.1％,78.0％,90.6％,and 72.0％,respectively.There were no significant differences between the CCRT group and NACT + CCRT group in 5-year OS (79.9％ vs.76.4％,P =0.443),DMFS (77.1％ vs.78.9％,P=0.972),RFS (91.6％ vs.89.8％,P=0.475),and PFS (71.6％ vs.72.2％,P=0.731).Subgroup analysis showed that compared with CCRT,NACT + CCRT did not significantly improve 5-year RFS in T3-4N0-1 patients (90.7％ vs.86.9％,P=0.376) and did not significantly improve 5-year DMFS in patients with advanced N-stage disease (57.6％ vs.69.7％,P =0.275).There were significantly higher numbers of individuals with neutropenia,decrease in hemoglobin,and upper gastrointestinal reactions in patients treated with NACT + CCRT than in those treated with CCRT (100 vs.52,P=0.000;64 vs.35,P=0.010;90 vs.63,P=0.044).Conclusions Compared with CCRT,NACT + CCRT does not significantly improve the prognosis in patients with locally advanced NPC and leads to significant increases in grade ≥ 3 toxicities (neutropenia,decrease in hemoglobin,and upper gastrointestinal reactions).The role of NACT in the treatment of locally advanced NPC needs further study

Objective To evaluate the long-term outcomes of patients with advanced N-stage nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) and the effects of IMRT combined with different chemotherapies on the patients' prognosis.Methods A retrospective analysis was performed on the clinical data of 179 patients with advanced N-stage NPC who were admitted to our hospital from January 2001 to January 2008.Of the 179 patients,33 received IMRT alone,and 146 received chemoradiotherapy (CRT).Among the 146 patients,71 received concurrent chemoradiotherapy (CCRT),66 received induction chemotherapy (IC) plus CCRT,and 9 received CCRT plus adjuvant chemotherapy (AC).Results The follow-up rate was 96.5％,and 133 patients were followed up for at least 5 years.The 5-year overall survival rate was 69.0％.The patients receiving IMRT alone and patients receiving CRT had 5-year overall survival rates of 47.7％ and 73.7％ (x2 =13.91,P =0.000),5-year distant metastasisfree survival (DMFS) rates of 49.2％ and 68.3％ (x2 =4.97,P =0.026),relapse-free survival rates of 74.5％ and 92.4％ (x2 =9.87,P =0.002),and progression-free survival rates of 37.5％ and 65.1％ (x2 =11.65,P =0.001).Among the patients receiving CRT,those receiving CCRT,IC plus CCRT,and CCRT plus AC had similar survival rates.IC plus CCRT resulted in a significantly higher DMFS than IMRT alone (x2 =4.65,P =0.031).Conclusions The distant metastasis rate is still high in patients with advanced N-stage NPC after IMRT,for whom IC plus concurrent chemotherapy and IMRT may be a better treatment regimen.

Objective To investigate the volume of prophylactic irradiation to the neck for stage N0 nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT).Methods Retrospective analysis was performed on the clinical records of 270 patients with stage N0 NPC (based on the 6th version of AJCC/UICC staging system),who underwent IMRT as the initial treatment in our center from 2003 to 2008.Among all the patients,171 received prophylactic upper-neck irradiation,and 99 prophylactic whole-neck irradiation.All of them received 6-MV X-ray IMRT to the primary focus of NPC and the lymphatic drainage area in the upper neck (Levels Ⅱ,Ⅲ,and Ⅴ A lymph nodes) at doses of 68 Gy/30fractions and 54 Gy/30 fractions over 6 weeks.In addition,the patients receiving prophylactic whole-neck irradiation had the lower neck and supraclavicular fossae treated by anterior neck semi-field conventional technique at a dose of 50 Gy/25 fractions.Results The median follow-up was 65.1 months (range 4-106months),and the follow-up rate was 93％.The patients undergoing prophylactic upper-neck irradiation and prophylactic whole-neck irradiation had 5-year disease specific survival rates of 95.3％ and 91.9％ (x2 =0.76,P =0.384),relapse-free survival rates of 99.4％ and 99.0％ (x2 =1.18,P =0.278),and distant metastasis-free survival rates of 98.8％ and 94.9％ (x2 =2.31,P =0.128).The 5-year distant metastasisfree survival rate was significantly higher in patients without retropharyngeal lymph node (RLN) metastasis than in those with RLN metastasis (99.4％ vs.93.7％,x2 =8.96,P =0.003).Grade 1-2 mucositis and pharyngitis were the most common acute adverse reactions in patients.At 24 months after IMRT,no grade 3 or 4 xerostomia and trismus were developed.Conclusions Prophylactic irradiation to the upper neck may be feasible for stage N0 NPC patients treated with IMRT.It is reasonable in the 7th version of AJCC/UICC staging system that NPC with negative cervical lymph nodes and positive RLNs is reclassified to stage N1.

Objective To study the effect of Corylin on A375 cells melanin synthesis,and explore its mechanism.Methods The cells were randomly divided into the control group, the estradiol group, and corylin group including 10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L, 100μmol/L. Estradiol estradiol intervention group were given 10-3 mol/L. Corylin group (10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L,100μmol/L) were given 10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L, 100μmol/L corylin intervention. The activity of proliferation were detected by MTT, NaOH method, dopa oxidation , both melanin content and tyrosinase activity (tyrosinase, TYR). TYR, yrosinase related protein (tyrosinase related protein, TRP)-1 and TRP-2 expression levels of mRNA were determined by RT-PCR.Results Compared with the control group, 10, 100μmol/L of Corylin group cell proliferation rate significantly decreased (P<0.01). The 1μmol/L, 10-1μmol/L, 10-2μmol/L of Corylin group cell melanin content, TYR significantly decreased (P<0.01 or P<0.05). The 1μmol/L corylin group TYR (0.303 ± 0.003vs. 0.628 ± 0.012), TRP-1 (0.313 ± 0.008 vs. 0.677 ± 0.022), TRP-2 (0.456 ± 0.028vs. 0.687 ± 0.020) mRNA expression level significantly decrease (P<0.01).Conclusions The results showed that Corylin could inhibit melanin synthesis, which worked probably through inhibiting the activity of TYR and cutting the mRNA expressions of TYR,TRP-1/2.

Objective To compare the efficacy and safety of conversion from CCB to ARB in the treatment of hypertension and proteinuria in kidney transplant recipients.Methods 127 long-term recipients who used CCB as their anti-hypertensive drug were enrolled.All recipients had stable renal function and no diabetes.Recipients were randomly assigned to experimental group (65 cases) which received ARB (Losartan,50～ 100 mg/day) instead of CCB,or control group (62 cases) which received routine CCB.All recipients were followed up for 2 years.Blood count,urinalysis,liver and kidney chemistry,blood lipid,serum electrolytes,24-h urine protein,blood concentration of CNI drugs and other biochemical indexes were observed.Results During the 2-year follow-up,the blood pressure of the two groups was maintained within normal level.The 24-h urine protein was decreased in the experimental group ( 176.32 ± 54.54 to 155.69 ± 62.25,P＜0.05),but increased slightly in the control group (P＞0.05).Although the blood lipid of the experimental group was not different before and after the follow-up,the high density lipoprotein (HDL) was increased statistically (2.25 ± 0.26 to 2.46 ±0.31,P＜0.05).The blood count,liver and kidney chemistry,serum potassium,blood concentration of CNI drugs in both groups showed no significant differences.Conclusion Both CCB and ARB could be effectively and safely used for the treatment of hypertension and proteinuria in kidney transplant recipients.ARB would be more effective in reducing cardiovascular disease (CVD)rate and decreasing proteinuria.

OBJECTIVETo study the clinicopathologic features, immunohistochemical profiles and prognosis of chromophobe renal cell carcinoma (ChRCC).

METHODSForty-two cases of ChRCC were retrieved from the archival files of the Affiliated Hospital of Qingdao University, 401 Hospital of PLA and Qingdao Municipal Hospital from 2003 to 2011. The clinical and pathologic features of the tumors were reviewed. Hale colloidal iron staining was performed and EnVision immunohistochemistry was used to detect the expression of a series of immunologic markers. Forty cases of clear cell renal cell carcinoma and 10 cases of renal oncocytoma were selected as controls.

RESULTSThe patients included 17 males and 25 females. The age of patients ranged from 39 years to 78 years (median age = 57 years). On gross examination, the tumors ranged from 2 cm to 19 cm in greatest dimension (mean size = 7.3 cm). Histologically, the tumors were mainly composed of solid sheets, acini or tubules of malignant cells. The tumor cells contained clear finely reticular ("chromophobe") and eosinophilic cytoplasm with perinuclear clearing. The nuclear outline was irregular and wrinkled. Nucleoli were inconspicuous and mitotic figures were barely seen. Hale colloidal iron stain was positive in all cases. Immunohistochemically, the tumor cells were variably positive for EMA (100%, 42/42), CK7 (95.2%, 40/42), Ksp-cad (92.9%, 39/42), CK18 (88.1%, 37/42), CD117 (61.9, 26/42), CD10 (31.0%, 13/42) and PAX2 (28.6%, 12/42). They were negative for vimentin, CA IX and TFE3. The follow-up period in 31 patients ranged from 2 to 77 months (average duration = 29 months). Three patients died of tumor metastasis 3, 8, 13 months respectively after the operation. Twenty-eight patients were still alive without evidence of tumor recurrence.

CONCLUSIONSChRCC predominantly occurs in middle-aged and elderly patients. It often carries a favorable prognosis. The presence of plant cell-like morphology, pale cells with uniform reticular microvesicular appearance and perinuclear clearing are characteristic histologic features. The diffuse positivity for Hale colloidal iron stain and EMA/CK7/Ksp-cadherin/CD117-positive immunoprofiles are also useful in differential diagnosis.

Adenoma, Oxyphilic ; metabolism ; pathology ; Adult ; Aged ; Cadherins ; metabolism ; Carcinoma, Renal Cell ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Immunophenotyping ; Keratin-18 ; metabolism ; Keratin-7 ; metabolism ; Kidney Neoplasms ; metabolism ; pathology ; surgery ; Lung Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Mucin-1 ; metabolism ; Nephrectomy ; methods ; Treatment Outcome