BACKGROUND:Calcineurin inhibitors reduce acute rejection rates and improve short-term graft survival in renal transplantation, but its nephrotoxicity associated with long-term use of calcineurin inhibitors remains an important issue. To both avoid exposure to calcineurin inhibitors and maintain effective immunosuppression, immunosuppressive agents such as sirolimus have emerged.
OBJECTIVE:To summarize the research progress of the two main protocols of sirolimus in kidney transplantation (de novo sirolimus-based therapy without calcineurin inhibitors and protocol conversion from a calcineurin inhibitor based therapy to sirolimus).
METHODS:With the key words of“kidney transplantation, sirolimus”in Chinese and in English, respectively, a computer-based search of articles was performed in CNKI (January 2000 to September 2013) and PubMed (January 1996 to September 2013) databases. Articles with the de novo sirolimus-based therapy without calcineurin inhibitors and protocol conversion from a calcineurin inhibitor based therapy to sirolimus were included.
RESULTS AND CONCLUSION:Sirolimus may obtain the advantages of no renal toxicity, anti-tumor and lower incidence of cytomegalovirus infections when compared with calcineurin inhibitors. But not al patients are suitable for sirolimus, and to screen patients strictly is the key of satisfactory clinical results. An appropriate treatment plan, drug monitoring of sirolimus, prevention and treatment of complications are essential features of the use of sirolimus.

Humans ; Kidney Failure, Chronic ; therapy ; Renal Insufficiency, Chronic ; therapy

Objective To analyze the clinical features of immunoglobulin A(IgA) nephropathy(IgAN) occurring in the context of pre-vious acute glomerulonephritis.Methods The clinicopathologic features of 108 cases(77 males,31 females,aged 3.2 to 14.0 years old) of IgAN were analyzed restrospectively with the onset of acute glomerulonephritis in this department from Jan.1994 to Dec.2005.Results Of 108 cases with IgAN,10 cases were with the onset of acute glomerulonephritis. All the 10 cases presented with edema, hematuria and proteinuria.Eight cases had macroscopic hematuria, lasting for 2 days to 2 months.Four cases had recurrent macroscopic hematuria,microscopic hematuria lasting for 16 months.Urine protein qualitative +-+++ lasted for 1-8 months.Two cases had hypertension;2 cases had increasing blood uria nitrogen and serum creatinine.The increase of anti-streptolysin O(ASO) titer was detected in 5 of 9 cases.Two cases had a high titer of DNase-B antibody, and 4 cases had hypocomplementemia.Eight cases had prodromal infection with an interval time varying from 1 to 5 days.Renal biopsies revealed mesangial proliferative glomerulonephritis in 9 cases and focal segmental glomerulosclerosis in 1 case, all with mesan-gial IgA deposition.Conclusions The interval time between the prodromal infection and nephritis symptoms is mostly short in IgAN with the onset of acute glomerulonephritis, while macroscopic and microscopic hematuria remain a fairly long time or recurrently aggravate. Renal biopsy is necessary to diagnose IgAN for this kind of children.

OBJECTIVE:To investigate the optimal administration route of ambroxol in the treatment of pediatric respiratory disease. METHODS:Totally 120 children with respiratory disease in pediatric department of our hospital during Jun. 2014-Jun. 2016 were divided into intravenous dripping group and atomization inhalation group according to even and odd-numbered admission order,with 60 cases in each group. Intravenous drip group was given Ambroxol hydrochloride injection 7.5 mg dissolved in 5%glucose solution 50 mL,ivgtt,bid;aerosol inhalation group was given aerosol inhalation of Ambroxol hydrochloride injection 7.5 mg,for 15 min each time,bid. The two groups were treated with 7 d. Clinical efficacies,p(O2)and p(CO2)level,the times of sputum absorption,clinical indexes and the occurrence of ADR were compared between 2 groups. RESULTS:Total response rate of atomization inhalation group(96.67%)was significantly higher than intravenous dripping group(78.33%);p(O2)level was sig-nificantly higher than intravenous dripping group,while the times of sputum absorption,fever disappearance time,asthma disap-pearance time,oxygen therapy time,pulmonary rales disappearance time,cough disappearance time and average hospitalization time were significantly less or shorter intravenous dripping group,with statistical significance (P<0.05). There was no statistical significance in p(CO2) level and the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Ambroxol is effective in the treatment of pediatric respiratory disease,and clinical efficacy of atomization inhalation is better than intravenous drop.

Objective To study the effect of Astragalus and Angelica mixture on growth failure induced by dexaraethasone in rats with nephrotic syndrome (NS) . Methods Forty six-week old male Sprague-Dawley rats with a starting weight of 160 ~ 180 g were randomly divided into five groups: control group, NS model group, NS group treated with Astragalus and Angelica mixture, NS group treated with dexamethasone, and NS group treated with Astragalus and Angelica mixture and dexamethasone. Weight, length, urine protein, and serum albuine were measured. Serum and urine concentrations of IGF-1 and IGFBP-3 were assayed by RIA and IRMA respectively; and IGF-1 mRNA and IGFBP-3 mRNA levels in liver were assayed by RT-PCR. Results Weight gain and length gain, serum IGF-1 and IGFBP-3 levels in NS model group were significantly lower than that of the control group and urine IGF-1 levels were higher than that of the control group (P

Objective To investigate the Reprimo and hMLH1 gene promoter methylation detection value in the diagnosis of early gastric cancer.Methods Chose patints in Shaanxi Provincial People’s Hospital from September 2013 to April 2014,50 cases of patients with chronic atrophicgastritis with intestinal metaplasia,50 cases of patients with gastricmucosal atypical hyperplasia,50 patients with gastric cancer,endoscopic gastric biopsy samples,and 30 cases of normal gastric mucosa biopsy tissues as control group.Analysis abnormal expression in Reprimo gene and hMLH1 genes promoter methylation,compared the differences.between groups of patients.Results The patients with gastric mucosatissues Reprimo and hMLH1 genes promoter methylation positive rate was significantly higher than that of normal group,the difference wasstatistically signifi-cant (P<0.05).Reprimo gene promoter methylation were:patients with chronic atrophic gastritis with intestinal metaplasia 28% (χ2 =10.18,P < 0.05).Patients with gastric mucosalatypical hyperplasia 56% (χ2 = 25.84,P < 0.05)and patients with gastric cancer 62% (χ2 = 30.36,P < 0.05).hMLH1 gene promoter methylation were:patients with chronic atrophic gastritis with intestinal metaplasia 20% (χ2 =4.39,P <0.05),patients with gastric mucosal atypical hyperplasia 44% (χ2 =15.13,P <0.05)and patients with gastric cancer 48% (χ2 = 17.41,P <0.05),high specificity of detection.Conclusion Reprimo and hMLH1 gene’s detect value in the diagnosis of early gastric cancer is very high,high specificity,it is an effec-tive way of diagnosis,treatment in clinical diagnosis of patients with broad prospects.

Objective To compare in vitro fertilization and embryo transfer( IVF-ET ) outcome of gonadotropin-releasing hormone( GnRH ) antagonist protocol and GnRH agonist long protocol in patients with polycystic ovary syndrome ( PCOS)and to provide reference for rational selection of ovulation stimulation protocol for PCOS patients. Methods One hundred and four patients with PCOS who underwent IVF-ET were randomly divided into two groups. In the study group,41 patients were subjected to the GnRH antagonist protocol;In the control group,63 patients were subjected to a long protocol of GnRH agonist. Doses and duration of gonadotropin therapy,the thickness of endometrium and the profile of hormone level on the day of HCG administration,the number of retrieved oocytes,the ratio of fertilization,the ratio of cleavage,the ratio of the good quantity embryos,implantation rate of embryo,pregnancy rate,the cycle cancellation rate and the incidence rate of ovarian hyperstimulation syndrome( OHSS)were recorded. Results The IVF-ET outcome of the two groups was similar with respects to the number of oocytes,the ratio of fertilization,the ratio of cleavage,implantation rate of embryo and the pregnancy rate( P﹥0. 05). Significant differences were found(P﹤0. 05)between the two groups regarding to the doses and duration of gonadotropin therapy,the levels of serum E2 and LH on the day of HCG administration,and the cycle cancellation rate. The incidence rate of OHSS was not significantly different ( 2. 44% vs. 12. 70%) between the two groups. Conclusion The duration of gonadotropins administration,the cycle cancellation rate,incidence of OHSS and the financial burdern are reduced in patients treated with GnRH antagonist. The growth of follicle,the ratio of fertilization,the ratio of cleavage,implantation rate of embryo and the pregnancy rate are not different between the two methods. The GnRH antagonist protocol is optimal for patients with PCOS.

Objective To research the feasibility and accuracy on echocardiography measurement aortic annulus diameter(AAD)at the plane of three Junctions of aortic valve leaflets by real-time three-dimensional transesophageal echocardiography(RT-3D-TEE).Methods Twenty-three patients underwent echocardiography and aortic valve replacement because of acquired aortic valve disease.The AAD was measured in parasternal left ventricle long axis view(TTE-AAD)by transthoracic echocardiography(TTE)preoperative.The AAD was measured in left ventricle long axis view(TEE-AAD)and the distance of three iunctions of aortic valve leaflets (N,L,R) was measured in aortic short axis view by RT-3D-TEE intraoperative.The three-dimensional full volume images were analyzed by online QLAB 7.0 software.The AAD was measured by standard cylindrical valve sizer (OP-AAD)before aortic valve replacement surgery,too.Results Comparing with the three aortic valve leaflets of acquired aortic valve disease,the lines between their junctions constituted an approximate equilateral triangle regardless of the cause and degree of disease,and the length of the three groups was no significant difference(P>0.05).There was no significant difference between TTE-AAD and OP-AAD group(P>0.05),and the correlation was good(r=0.84).The N,L and R group compared separately with the OP-AAD group, there was no significant difference(P>0.05)and correlation was superior to TTE-AAD group(r=0.94, 0.97, 0.96).The difference between TEE-AAD and OP-AAD were significant(P<0.01).Conclusions Echocardiography measurement of AAD at the plane of three junctions of aortic valve leaflets is feasible,and it is better accuracy and repeatability comparing with parasternal left ventricle long axis view.

Objective To explore the risk factors of prognosis for children with acute kidney injury (AKI). Methods Clinical data of 118 children with AKI, including the causes,clinical characteristics, laboratory features, renal pathological findings, treatment and outcome, were reviewed retrospectively. Association between risk factors and prognosis was analyzed. AKI was defined by the new classification criteria of the Acute Kidney Injury Network. Prognostic factors were determined by univariate methods and stepwise multiple logistic regression analysis. Results One hundred and eighteen patients (83 male, 35 female) were enrolled in the study, who admitted in our department between January 1, 2005 and May 31, 2008. Median age at the time of AKI children was 7.5 years (range 1 day-14 years), among whom 28.0% (33 cases) was less than 3.0years, 17.8% (21 cases) between 3.0 and 7.0 years and 54.2% (64 cases) more than 7.0 years.Patients' AKI was classified according to the staging system as follows: 52.5% stage 1, 32.2%stage 2 and 15.3% stage 3. The common causes of AKI children were infectious and autoimmune diseases (39.8%), renal vascular disease (27.1%) and circulatory disturbance (11.9%). Hospital mortality was 21.2%. Multivariate analysis showed that independent risk factors for death were need for mechanical ventilation (OR=51.75, P＜0.01＝, sepsis/septic shock (OR=14.76, P＜0.01＝, severe acidosis (OR=11.38, P＜0,01＝, and white blood cells (WBC) count more than 20.0×109/L (OR=8.51, P＜0.01＝. Conclusion Infectious and autoimmune diseases, renal vascular disease and circulatory disturbance are the common causes of AKI children. The important risk factors of death in AKI children are need for mechanical ventilation, sepsis/septic shock, severe acidosis, and WBC count more than 20.0×109/L.

Objective To evaluate the effect of uterine-reserved in the pelvio floor reconstruction,and select the best surgery for patients. Methods Through the observation and follow-up for 14 cases of uterine-reserved (experimental group) and 17 cases of uterine-removed (control group), to compare the information during the surgery, postoperative recovery, and quality of life of the two groups. Results The operation time, blood loss, postoperative discharge time, antibiotics application time and hospitalization time in experimental group were significantly lower than those in control group(P ＜ 0.05). The paruria, abdominal distention in experimental group [14%(2/14), 14%(2/14)] were significantly lower than those in control group [53% (9/17), 24% (4/17)] (P ＜ 0.05), and sexual satisfaction was significantly higher in experimental group than that in control group [71% (10/14) vs. 47% (8/17)] (P ＜ 0.05). There were no significant difference in pelvic pain, constipation of the two groups (P＞ 0.05). The POP-Q scores were normal after the operation both the two groups, each group beforeand after surgery compared the POP-Q score, were statistically significant (P ＜ 0.05). Conclusions Uterine-r eserved in the pelvic floor reconstruction can maintain the structural stability of the pelvic floor, and has the advantage of shorter operation time, less bleeding, more rapid recovery. Recent results are similar with hysterectomy, can reduce the risk of perioperative period to the elderly women.