Objective To investigate the feasibility and value of combined administration of rapamycin and low dose of cyclosporin A in kidney transplantation recipients. Methods Twenty-five recipients who received their kidney transplantations for 2 months to 10 years were transferred to a new immunosuppression regimen of combined administration of rapamycin,low dose of cyclosporin A and prednisone. During the clinical observation,the average serum trough level of cyclosporin A was maintained between 0.042 and 0.083 μmol/L,and the average serum trough level of rapamycin was controled to 4～8 μg/L. Meanwhile, the dosage of immunosuppressive drugs was adjusted properly according to the white blood cells counting,liver function,blood lipid level and clinical settings.Twenty-five kidney transplant recipients with usual immunosuppression regimen of cyclosporin A in combination with MMF and prednisone served as controls. Results Druing a follow-up period of 2 to 8 months,no acute rejection events were found in this group. All the recipients survived well with functional renal grafts. Two patients in the experimental group quitted during the follow-up. One was incurred to serious pulmonary infection diagnosed as cytomegalovirus infection,and another was sufferred from persistent unknown fever. Other main adverse effects included leucopenia, hyperlipemia and dental ulcer,similarly as control group. No significant abnormal liver function event was found in this group. Conclusions This new immunosuppression regimen of combined administration of rapamycin,low dose cyclosporin A and prednisone in kidney transplantation recipients could avoid or diminish the adverse and toxic effects of calcineurin inhibitors,mainlain well-functional allografts and not increase the incidence of severe untoward reactions. Meanwhile,the costs for taking medicine were also significantly reduced with this regimen. Therefore,it would be an ideal and optimal immunosuppressive maintainence regimen.

Objective To observe the effect of different methods such as combined treatment of traditional Chinese and western medi-cine, the simple excision and expanded resection for the treatment of granulomatous lobular mastitis. Methods 60 cases of patients treated in our hospital from Jan. 2010 to Jan. 2013 were enrolled in this study, and they were confirmed the diagnosis of granulomatous lobular mas-titis by pathology examination. According to randomly number table, they were divided into three groups and they were given the treatment of combined treatment of traditional Chinese medicine and Western medicine, the simple excision, and expanded resection respectively. Where-after, the therapeutic effect of the three groups were observed. Results There were 9 cases (45. 0%) were of cure and 11 cases (55. 0%) of recurrence in the combined treatment group. There were 16 cases (80. 0%) of cure and 4 cases (20. 0%) of recurrence in the simple ex-cision group. There were 8 cases (90. 0%) of cure and 2 cases (10. 0%) of recurrence in the combined treatment group. It shows that the recurrence rate of combined treatment group was higher than the other two groups (P<0. 05). The satisfactory rate of breast appearance after treatment were 17 (85%), 15 (75%) and 16 (80%) respctively, and there is no significant difference (P>0. 05). Conclusion The effect of extended resectionin for the treatment of granulomatous is better and it has important clinical value.

Objective To investigate the clinical pattern,therapeutic principle and influencing factors of interstitial pneumonia in renal allograft recipients.Method The general information,clinical manifestation,treatment and outcomes of 30 recipients with interstitial pneumonia after renal transplantation from Nov.2006 to Dec.2013 were analyzed retrospectively.Result Twenty-nine of 30 patients developed interstitial pneumonia between 2 to 6 months post-transplant.The total course of the pneumonia lasted for 34.9 ± 7.5 days on average.Chest CT scans were used to monitor severity of interstitial pneumonia each week.The mean duration between the onset to the fastigium of pneumonitis was approximately 14.8 ± 1.9 days.The mean duration of the fastigium lasted for 7.3 ±3.6 days,after that the patients usually started to recover.Deteriorated chest CT scan findings and long terms of the fastigium usually indicated poor outcomes.The mean duration of the recovery period was 13.1 ± 3.7 days.After adjusted administration of methylprednisolone,antibiotics,antifungal agents,nutritional support as well as immunosuppressive drugs,23 patients with mild and moderate pneumonia by the chest CT scans were cured and discharged.However,4 of the 7 patients with severe pneumonia by the chest CT scans died.Conclusion The progression of interstitial pneumonia after renal transplantation is characterized by a more consistent regularity.After adjusted administration of methylprednisolone,antibiotics,antifungal agents,nutritional support as well as immunosuppressive drugs,renal allograft recipients with interstitial pneumonia could obtain a good therapeutic effect without over-treatment.

OBJECTIVES:To evaluate the efficacy of rapamycin(RPM)oral liquid plus cyclosporine(CsA)on the preven?tion of early acute rejection after renal allograft.METHODS:20patients undergoing primary renal allografting were randomly divided into RPM trial group and Azathioprine(Aza)control group,10cases in each group,who were respectively assigned to receive CsA and adrenocortial hormones-based immunosuppression for6months,indexes including survival rates of recipients/kidneys,incidences of acute rejection and adverse reactions between2groups were compared.RESULTS:For the17patients who had finished6-month treatment,the survival rates(recipients/kidneys)were100%.Only2episodes of acute rejection occurred in one case in Aza group.Both groups had2cases of severe adverse episodes.CONCLUSIONS:The combined therapy pf RPM plus CsA is effective in the prevention of acute renal allograft rejection,and it can maintain renal function at a good level.Nevertheless,it may increase the hepatotoxicity of CsA.

Objective To investigate the safety and efficacy of pegylated interferon (PEG-IFN) and ribavirin for chronic hepatitis C following renal transplantation.Method Nine adult renal transplant recipients of ＞ 12-month duration,infected with hepatitis C virus (HCV),and with stable renal graft function were recruited.All patients were administered with PEG-IFN-α 2b 50 μg/week,plus ribovirin 400-600 mg/day.HCV viral load was reexamined monthly.Consolidation therapy lasted for 3-9 months after initial remission of HCV-RNA.Viral response,adverse effects and changes in hemogram,alanine aminotransferase and andserum creatinine were also monitored.Result The duration of treatment for 9 patients was 4-20 months.Sustained virologic response (SVR) occurred in 6 patients with no relapse during 6-month follow up period after the ceasation of the treatment.Two patients,with rapid virologic response,had a virologic relapse after completing their 3-month consolidation therapy.One patient maintained no obvious virologic response during 8 months of treatment.Renal function was kept in normal range in all patients and no one experienced a rejection episode during or after PEG-IFN-α 2b therapy.The major adverse reactions included influenza-like syndrome (fever,muscle soreness,anorexia),transient bone marrow suppression and anemia.All of the adverse reactions were transient and tolerable,and no discontinuation of PEG-IFN-a 2b therapy was required in all these patients.Conclusion For renal transplant recipients with stable renal graft function,treatment with PEG-IFN-α 2b and ribavirin has high efficacy in the treatment of HCV and is not associated with high risk of acute rejection of renal allografts.

Objective To investigate the effect of conversion from cyclosporine A (CsA) to tacrolimus (Tac) on chronic allograft nephropathy (CAN). Methods 153 CAN patients undergoing kidney transplantation received CsA, mycophenolate mofetil (MMF) and prednisone (CsA-MMF-Pred) regimen after kidney transplantation, and divided into 2 groups according to whether CsA were maintained in the immunosuppressive regimen: CsA + MMF + Pred group (CsA group, n = 45); Tac + MMF + Pred group (Tac group, n = 108). The patients were followed up with patient/kidney survival rate, acute rejection incidence, renal function, 24-h proteinuria and adverse events of immunosuppressive drugs for 12 months. Results Compared with CsA group, the transplanted kidney survival rate was significantly higher in Tac group (93. 5 % vs 86.6 %, P＜0. 05). Acute rejection (AR) was diagnosed in 4. 4 % (2/45) of recipients in CsA group and 3. 7 % (4/108) in Tac group (P＞0. 05) respectively. Acute rejection (2 cases in CsA group and 4 in Tac group) was reversed by 500 mg of methylprednisolone for consecutive 3 days, and the patients in Tac group showed a significantly lower degree of interstitial fibrosis and tubular atrophy (IF/TA) (P＜0. 05).Renal allograft functions and 24-h proteinuria during a follow-up period of 12 months were significantly improved in Tac group (P ＜ 0. 05). Incidence of mild hyperglycemia in Tac Group (13.8 %, 15/108) was significantly higher than in CsA group (4.4 %, 2/45), and that of hypertension in Tac group (22. 2 %, 24/108) was significantly lower than in CsA group (55.6 %,25/45). CsA-related side effects (such as hirsutism and gingival hypertrophy) in 17 patients were greatly improved after conversion from CsA to Tac treatment. Conclusion The conversion from CsA to Tac on the patients with CAN can improve renal allograft function, retard the progression of renal allograft dysfunction, reduce the incidence of CsA-related side effects and not generate serious adverse effects of Tac.

The subcutaneous adipose tissue from the inguen of four Sprague-Dawley rats was obtained, then digested with one volume of collagenase type I and cultured with BGJb medium. The obtained adipose stromal cells were induced in human endothelial-SFM for 7 d. The cells were observed under inverted microscope every day and identified by transmission electron microscope and immunocytochemical staining with factor VIII antigen. The results showed the induced cells uniformly had characteristic cobblestone morphology of endothelial cells. Factor VIII antigen staining was positive in cytoplasm. Under transmission electron microscope, the cells displayed many finger like microvilli and numerous lysosomes, mitochondria, a few coarse endoplasmic reticulum and Weibel-Palade bodies. The characteristics of the rat adipose tissue-derived endothelial cells were consistent with those of vascular endothelial cells derived from other tissues. It seems that subcutaneous adipose tissue may represent a new alternative source of endogenous vascular endothelial cells.
Adipose Tissue ; cytology ; Animals ; Cell Culture Techniques ; methods ; Cell Differentiation ; Endothelial Cells ; cytology ; Endothelium, Vascular ; cytology ; Male ; Rats ; Rats, Sprague-Dawley ; Stromal Cells ; cytology

OBJECTIVESTo simplify the enteric drainage (ED) procedure and to decrease surgical and metabolic complications in simultaneous pancreas-kidney transplantation (SPK) patients.

METHODSBetween June 2000 and June 2002, nine patients with insulin-dependent diabetes mellitus (IDDM) and uremia underwent simultaneous pancreas-kidney transplantation. The arterial inflow of the pancreas was based upon the right external iliac artery, while venous drainage was systemic via the external iliac vein. The allografts' exocrine secretions were drained into the proximal jejunum via a two-layer hand sewn, side-to-side donor duodenum to proximal small bowel anastomosis after reperfusion. No Roux-en-Y an astomosis of the jejunum was performed. The kidney graft was placed in the left iliac fossa. Quadruple immunosuppressive therapy with antilymphocyte globulin or anti-CD25 monoclonal antibody (Zenapax), tacrolimus, mycophenolate mofetil and steroids was standard treatment in all patients.

RESULTSThis procedure was successfully applied in all 9 patients without complication referable to the technique. All patients had achieved euglycemia and excellent renal function, and stopped being dependent on an external insulin source. Fasting serum glucose fell from 9.5 preoperatively to 4.8 mmol/L and remained stable thereafter. At the time this paper was written, the grafts from eight patients were functioning well.

CONCLUSIONSOur primary experience suggests that SPK with ED without Roux-en-Y anastomosis represents a more physiologic milieu, and a viable alternation to replace the bladder (BD) as the primary route of drainage for exocrine secretions of the pancreas. It is a feasible and safer procedure.

Adult ; Amylases ; blood ; Drainage ; methods ; Female ; Humans ; Insulin ; blood ; Intestines ; Kidney Transplantation ; methods ; Male ; Pancreas Transplantation ; methods

Objective:To investigate the clinical effect of open reduction and internal fixation for the treatment of double-column acetabular fractures by lateral rectus abdominis approach.Methods:A retrospective case series study was conducted to analyze the data of 44 patients with double-column acetabular fractures admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2015 to June 2019. There were 29 males and 15 females, with the age of 21-72 years [(41.3±8.4)years]. All patients were treated by open reduction and internal fixation through a single lateral rectus abdominis approach. Operation time, intraoperative blood loss and fracture healing time were recorded. The quality of fracture reduction was assessed according to the Matta reduction criteria, and hip function by the modified Merle D'Aubigne and Postel score at last follow-up. Postoperative complications were observed.Results:A total of 40 patients were followed up and 4 patients were lost to follow-up. The follow-up time was 12-46 months [(30.5±6.4)months]. The operation time ranged from 45 to 150 minutes[(111.2±20.6)minutes], and the intraoperative blood loss was 200-1 200 ml [(398.5±78.5)ml]. The fractures were healed, with the healing time of 10 to 16 weeks [(11.8±3.3)weeks]. At last follow-up, according to the Matta criteria, the results were excellent in 29 patients, good in 7, fair in 3, poor in 1, with the excellent and good rate of 90%. At last follow-up, according to the Merle D'Aubigne and Postel score, the results were excellent in 27 patients, good in 6, fair in 6, poor in 1, with the excellent and good rate of 83%. One patient had heterotopic ossification with no impact on hip function, and no special treatment was given. One patient with the reaction of foreign body was finally controlled by anti-infection treatment, and the internal fixation was removed again one year after operation. Three patients with mild osteoarthritis were relieved by oral anti-inflammatory and analgesic drugs. Two patients with deep venous thrombosis of lower extremities were cured by anti-coagulation therapy such as low molecular weight heparin.Conclusions:The single rectus abdominis approach for open reduction and internal fixation of double-column acetabular fractures can take into account the anterior column, quadrilateral body and posterior column. Meanwhile, this approach has advantages of satisfactory acetabular reduction and functional recovery, and less postoperative complications, suggesting an alternative procedure for treatment of double-column acetabular fractures.

Objective To analyze the safety of renal transplant from donors with primary central nervous system (CNS) tumors.Methods We retrospectively analyzed the clinical data of 33 donors with primary CNS tumors and the 63 corresponding renal recipients between January 2013 and December 2016 in Tongji Hospital.Results The mean period from diagnosis as primary CNS tumor to donation was about (21.8± 46.4) months (range:0.5 to 192.0 months).The pathological classification of these tumors included gliomas,meningioma,medulloblastoma,etc.Besides,there were 10 donors with high-grade CNS malignancies.Eleven donors have ever been through at least one of the four treatments (craniotomy,V-P/V-A shunt,radiotherapy and chemotherapy),14 donors have undergone none,and the clinical data of rest were unavailable.All the 63 recipients got well renal function after transplant.During an average follow-up of (15.9 ± 8.2) months (range:2.7 to 35.5 months),one recipient got donor-derived rhabdoid tumor 4 months posttransplant,underwent comprehensive treatments,including allograft nephrectomy,radiotherapy,chemotherpy and returned to hemodialysis,while the 62 cases got no donor-derived tumors.Conclusion Tumor transmission of renal allograft from donors with primary CNS tumors is inevitable but with low risk,which means this kind of donors can be used with careful assessment,full informed consent and good balance between wait-list death and tumor transmission.