Anti-Bacterial Agents ; therapeutic use ; Antibiotic Prophylaxis ; Humans ; Intraoperative Care

Aged ; Biopsy ; Bone Marrow Examination ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphoma, B-Cell ; diagnosis ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Acetyl-CoA C-Acyltransferase ; deficiency ; Amino Acid Metabolism, Inborn Errors ; diagnosis ; enzymology ; metabolism ; Diagnosis, Differential ; Humans ; Infant ; Isoleucine ; metabolism ; Male

10.3969/j.issn.1008-9691.2013.03.005

OBJECTIVE: Tacrolimus is widely used in organ transplant. However, the long-term effects of tacrolimus on Asian, in particular in Chinese people, are few. The aim of this study is to evaluate the efficacy and safety of long-term curative effect of tacrolimus used in kidney transplantation patients in China.DATA SOURCES: Electronic and manual retrieve of Medline database, Chinese journal full-text database, Cochrane library, and CEBM/CCD, and relevant medical journals in China were applied.DATA SELECTION: Published randomized controlled trials on tacrolimus in kidney allograft recipient were retrieved, and the data were underwent Meta analysis. Odds ratio (OR) and its 95% confidence interval (CI) were used as the measurement parameter of efficacy comparison. The statistical analyses were performed using Stata software.MAIN OUTCOME MEASURES: ①The survival ratio of patient/kidney after 1 year. ②The survival ratio of patient/kidney after 3 years. ③Rejection ratio after 3 years. ④Infection rate after 3 years. ⑤Incidence of liver dysfunction after 3 years. ⑥Blood glucose disorder after 3 years.RESULTS: A total of 3 trials were eligible for the inclusion efficacy, including 3 Chinese trials and 0 foreign trials. Results of meta-analysis indicated that tacrolimus prevented the recipients of kidney transplantation from rejection effectively in three years [OR=0.40, 95%CI (0.27-0.61), P < 0.000 1]. Tacrolimus prevented the recipients of kidney transplantation from impaired liver function in three years [OR=0.28, 95%CI (0.15-0.52), P < 0.000 1]. No statistical difference of the 1-year and 3-year survival rate of patients/ kidney was found in the patients between group tacrolimus and group cyclosporine. Statistical difference of blood glucose disorder were found in the patients between group tacrolimus and group cyclosporine [OR=2.39, 95%CI (1.41-4.05), P=0.001].CONCLUSIONS: Tacrolimus prevented the recipients of kidney transplantation from rejection and impaired liver function effectively in three years in China. No statistical difference of the 1-year and 3-year survival rate of patients/kidney was found in the patients between two groups. In addition, the main side effect of tacrolimus is blood glucose elevation.

BACKGROUND: Removal of immunosuppressants in patients with recurrent tumor in long-term following organ transplantation is always a hot controversial point in academic circles. To further elevate clinical efficiency, people began to invent new immunosuppressant and studied immune efficiency of various immunosuppressant component. They tried to reduce the application of cyclosporin A (CsA).OBJECTIVE: To analyze the CsA safe withdrawal of a case of kidney recipients, at 18 years after renal transplantation, who developed bladder carcinoma and renal pelvic carcinoma at 11 years and 18 years after transplantation, respectively. METHODS: After identified diagnosis, we performed transurethral resection of bladder tumor (TURBt) and total nephroureterectomy merobladder excision. Pathologic examination revealed grade Ⅰ-Ⅱ of bladder and renal pelvic transitional cell carcinoma. After the operation, patient was treated with immune suppression program of CsA withdrawal gradually in 12 days.Within 12 days, 5 mg CsA was decreased every 3 days, and complete withdrawal was done at 12 days. The dosage of azathioprine tablets and prednisone acetate tablets was not changed. Serum creatinine levels were rechecked every 3 days during drug withdrawal, and blood pressure, urine volume, physical symptom of patients and ultrasound of transplanted kidney were observed.RESULTS AND CONCLUSION: During the three months of CsA withdrawal, the blood creatinine levels were from 65 to indicated that the CsA gradually withdrawal of a case of kidney recipients after renal transplantation, who developed transitional cell carcinoma and was performed transurethral resection of bladder tumor (TURBt) and total nephro- ureterectomy merobladder excision, was safe. No tumor relapse or diversion was found.

Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with recombinant tissue-plasminogen ac-tivator(rt-RA) for treatment of acute cerebral infarction (ACI) .Methods The randomized controlled trials (RCT ) of intra-arterial thrombolysis with rt-PA for treatment of ACI were selected from Cochrane Library ,Medline ,Embase and CBM by the computer re-trieval .A meta analysis of the data were analyzed by using RevMan 5 .1 software .Results A total of 473 patients in 9 selected RCTs were involved in the systematic review .Meta-analysis results disclosed suggested that the effectiveness of intra-arterial thrombolysis treated ACI group was better than that of intravenous thrombolysis group [RR= 1 .26 ,95% CI(1 .09 ,1 .45) ,P=0 .002] .No difference was observed between the two groups in intracranial hemorrhage and mortality rate .Conclusion The current evidence showed that ,the clinical effect of intra-arterial thrombolysis with rt-PA for treatment of ACI was obviously superior to that of intravenous thrombolysis ,but the result still needs to be confirmed by large-sample RCTs .

Objective To investigate the effect of recipient's pre-transplant triglyceride (TG) abnormalities on early graft function (EGF) after kidney transplantation.Methods According to the inclusion and exclusion criteria,154 identified living-kidney transplant recipients in the 309 Hospital of Chinese PLA from Jan.2011 to Dec.2014 were enrolled in present study,including 124 males and 30 females,and aged of 31.9 ± 8.4 years.The cohort was divided into two groups:TG normal group (0.40＜TG≤1.70mmol/L,n=107) and TG abnormalities group (TG＞l.70mmol/L or require lipid lowering therapy,n=47).The incidences of poor early graft renal function (PEGF),slow graft function (SGF) and delayed graft function (DGF) were compared between the two groups,and then the serum creatinine (Scr) levels were compared among the patients showing immediate graft function (IGF) at 3rd,7th and 30th day after transplantation.The ROC curve was drawn up taking TG as diagnosis index to explore the optimal cut-offvalue for predicting PEGF,SGF and DGF after transplantation.Results Compared with the TG normal group,the TG abnormalities group showed significantly higher incidence of PEGF and DGF (P＜0.05).Among the IGF patients,the TG abnormalities group showed higher Scr level at the 7th and 30th day after transplantation (P＜0.05).The area under ROC curve (AUC) reflected TG levels for PEGF,SGF and DGF were 0.774,0.704 and 0.818,respectively (P＜0.05).The optimal cut-offvalues were all 1.37mmol/L.Conclusions Recipients with abnormal pre-transplant TG level may have worse EGF after renal transplantation.The risk of developing PEGF,S GF and D GF tends to emerge when pre-transplant TG level is higher than 1.37mmol/L.

Objective To summarize the clinical manifestations, diagnosis, and treatment of infantile Sandhoff disease. Methods The clinical data of one case with infantile Sandhoff disease were reviewed retrospectively. The related literatures were reviewed. Results The girl aged 1 year and 2 months suffered from psychomotor regression and intractable convulsions. The parents were consanguineous marriage. The fundus microscopy showed fundus erythema. Brain magnetic resonance imaging showed an abnormal signal of long T2WI and identical T1WI at left pons, white matter edema, and diffuse demyelination. No abnormal karyotype was observed. A chromosome microarray suggested multiple large homozygous chromosomes segments. The second generation gene sequencing showed deletion of c.1263_1268delTGAAGT:P. (Glu422_Val423del) deletion in exon 11 and a shear mutation of c.1614_2A>G:P? in intron 13 of HEXB gene which were carried by her parents respectively . The activity of HexA, HexA & HexB were 84 and 112 nmol?mg?1?h?1, respectively. Finally, this girl was diagnosed of infantile Sandhoff's disease. After treatment with valproate, levetiracetam combined with antiepileptic and glucocorticoids, episodes of convulsions were decreased gradually, and the reaction was better than before. In 5 months of follow up, the condition was stable, and no progression and no seizures exist. Her mother got pregnant again and received an amniocentesis on her 21+6 weeks of pregnancy, and results suggest that the fetus had the same mutation as this girl. Conclusions Sandhoff's disease is a type of rare hereditary lysosomal disease, characterized by progressive neurological impairment. Currently there are no effective treatments. Genetic testing is helpful in the diagnosis and prenatal diagnosis.

Objective To observe the expression of adrenomedullin (ADM) mRNA in hepatic tissue of rats with acute necrotizing pancreatitis (ANP) complicated with hepatic injury.Methods Sixty-four SD rats were randomly divided into control group and ANP group with 32 rats in each group.In ANP group,ANP model was induced by retrograde injection of 5％ sodium taurocholate into biliopancreatic duct of rats.Rats in control group only received sham operation and pancreas manipulation.All the rats were sacrificed at 3,6,12,24 h after the operation.The serum levels of amylase,alanine aminotransferase (ALT),aspartate aminotransferase (AST) and ADM were detected.Pathological changes in pancreatic and hepatic tissue were examined.The expressions of ADM mRNA in hepatic tissue were evaluated by fluorescence quantitative PCR.Results The serum concentrations of amylase,ALT,AST were (7229 ±968),(174.2 ±28.0),(657.7 ± 139.0) U/L,which were significantly higher than those in control group [(2036 ± 292),(104.3 ± 22.1),(419.7 ± 86.3) U/L],and the difference between the two groups was statistically significant (P ＜ 0.05 or P ＜0.01).Pathological injury of pancreas and liver tissue in ANP gradually aggravated with time,and the pathological scores at 12 h were (11.60 ± 1.51),(2.60 ± 0.89),which were significantly higher than those in control group (1.20 ± 0.77,0),and the difference between the two groups was statistically significant (P＜0.01).The serum concentrations of ADM in ANP group increased at 3 h after ANP induction,and reached (38.53 ± 6.25)pg/ml at 12 h,which was significantly higher than that in control group [(28.99 ±3.92)pg/ml] ; the concentrations of ADM in liver tissue increased at 3 h after ANP induction,and reached (3.00 ± 1.49) at 6 h,which was significantly higher than that in control group (1.04 ± 0.20),and the difference between the two groups was statistically significant (P＜0.05 or P＜0.01).Conclusions The expression of ADM mRNA in rat 's hepatic tissue increases in the early stage of ANP,and the serum concentration of ADM also increases.