Objective:To explore the mechanism of tumor necrosis factor-α-inducible protein-8(TNFAIP8)regulating CD4+CD25+FOXP3+Treg cells involved in immune tolerance of kidney transplantation model.Methods:Wistar rats were used as recipients of kidney transplantation and divided into control,model,model+TNFAIP8,model+TNFAIP8+CD25 groups,with 12 rats in each group.SD rats were used as kidney donors,and the left kidney was transplanted into Wistar rats.Lentivirus-TNFAIP8(300 μg/kg)was injected into the tail vein to overexpress TNFAIP8.CD25 antibody at 10 mg/kg was injected into the tail vein to inhibit the differen-tiation of Treg.Renal tissue injury,renal function,Treg cell ratio,protein levels of TNFAIP8 and FOXP3 were compared.Results:Compared with control group,BUN[(23.85±20.68)mmol/L]and Scr[(112.49±10.02)μmol/L]in model group were increased,while proportion of Treg cells[(3.01±0.32)%],protein levels of TNFAIP8 and FOXP3 were decreased(P<0.05).BUN[(11.74±11.04)mmol/L]and Scr[(65.56±6.15)μmol/L]in model+TNFAIP8 group were lower than those in model group,Treg level[(6.74±0.68)%],TNFAIP8 and FOXP3 protein levels were higher than those in model group(P<0.05).BUN[(20.26±2.19)mmol/L]and Scr[(100.82±8.27)μmol/L]in model+TNFAIP8+CD25 group were higher than those in model+TNFAIP8 group,while the levels of Treg[(3.34±0.36)%]and FOXP3 protein were lower than those in model+TNFAIP8 group(P<0.05).Conclusion:TNFAIP8 involved in immune tolerance in kidney transplantation by regulating CD4+CD25+FOXP3+Treg cells.

Objective:To explore the mechanism of tumor necrosis factor-α-inducible protein-8(TNFAIP8)regulating CD4+CD25+FOXP3+Treg cells involved in immune tolerance of kidney transplantation model.Methods:Wistar rats were used as recipients of kidney transplantation and divided into control,model,model+TNFAIP8,model+TNFAIP8+CD25 groups,with 12 rats in each group.SD rats were used as kidney donors,and the left kidney was transplanted into Wistar rats.Lentivirus-TNFAIP8(300 μg/kg)was injected into the tail vein to overexpress TNFAIP8.CD25 antibody at 10 mg/kg was injected into the tail vein to inhibit the differen-tiation of Treg.Renal tissue injury,renal function,Treg cell ratio,protein levels of TNFAIP8 and FOXP3 were compared.Results:Compared with control group,BUN[(23.85±20.68)mmol/L]and Scr[(112.49±10.02)μmol/L]in model group were increased,while proportion of Treg cells[(3.01±0.32)%],protein levels of TNFAIP8 and FOXP3 were decreased(P<0.05).BUN[(11.74±11.04)mmol/L]and Scr[(65.56±6.15)μmol/L]in model+TNFAIP8 group were lower than those in model group,Treg level[(6.74±0.68)%],TNFAIP8 and FOXP3 protein levels were higher than those in model group(P<0.05).BUN[(20.26±2.19)mmol/L]and Scr[(100.82±8.27)μmol/L]in model+TNFAIP8+CD25 group were higher than those in model+TNFAIP8 group,while the levels of Treg[(3.34±0.36)%]and FOXP3 protein were lower than those in model+TNFAIP8 group(P<0.05).Conclusion:TNFAIP8 involved in immune tolerance in kidney transplantation by regulating CD4+CD25+FOXP3+Treg cells.

Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.The patients were divided into observation group(n=15)and control group(n=40)according to received perioperative cranial ultrasound or not.The general data and surgical data were compared between groups,and ultrasonic data of observation group were analyzed.Results The proportions of good prognosis 1 and 6 months after operation in observation group were both higher than those in control group,while the incidence of cerebral infarction in observation group was lower than that in control group(all P＜0.05).No significant difference of general data nor other surgical data was found between groups(all P＞0.05).Acute encephalocele occurred in 1 case in observation group during operation,and cranial ultrasound accurately showed the contralateral secondary epidural hematoma.Increased intracranial pressure in different degrees were found in all 15 cases(15/15,100％)in observation group after operation with transcranial color coded Doppler(TCCD)or transcranial Doppler(TCD),while cerebral vascular spasm was observed in 5 cases(5/15,33.33％),among them 4 cases(4/5,80.00％)were diagnosed cerebral infarction based on CT examination.Conclusion Cranial ultrasound could be used to evaluate changes of sTBI in perioperative period and guide adjusting treatment strategy in time,being valuable for reducing risk of postoperative cerebral infarction and improving prognosis.

Objective To compare the performance of three deep-learning models （VGG19, Inception-V3 and Inception-ResNet-V2） in automatic bone age assessment based on pelvic X-ray radiographs. Methods A total of 962 pelvic X ray radiographs taken from adolescents （481 males, 481 females） aged from 11.0 to 21.0 years in five provinces and cities of China were collected, preprocessed and used as objects of study. Eighty percent of these X ray radiographs were divided into training set and validation set with random sampling method and used for model fitting and hyper-parameters adjustment. Twenty percent were used as test sets, to evaluate the ability of model generalization. The performances of the three models were assessed by comparing the root mean square error （RMSE）, mean absolute error （MAE） and Bland-Altman plots between the model estimates and the chronological ages. Results The mean RMSE and MAE between bone age estimates of the VGG19 model and the chronological ages were 1.29 and 1.02 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-V3 model and the chronological ages were 1.17 and 0.82 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-ResNet-V2 model and the chronological ages were 1.11 and 0.84 years, respectively. The Bland-Altman plots showed that the mean value of differences between bone age estimates of Inception-ResNet-V2 model and the chronological ages was the lowest. Conclusion In the automatic bone age assessment of adolescent pelvis, the Inception-ResNet-V2 model performs the best while the Inception-V3 model achieves a similar accuracy as VGG19 model.
Adolescent ; Adult ; Age Determination by Skeleton ; Child ; China ; Female ; Humans ; Male ; Pelvis ; Radiography ; Young Adult

Objective To investigate the clinical efficacy of methylprednisolone intravenous infusion and to take oral prednisone for patients with pulmonary infection after renal transplantation. Methods One hundred and thirty?six patients with severe pulmonary infection after renal transplantation in our hospital from January 2013 to January 2016 were enrolled and randomly divided into 2 groups. All patients were treated with immunosuppressant adjustment based on the basis of routine treatment. Patients in the observation group were applied methylprednisolone, while patients in the control group were applied prednisone. The clinical efficacy between 2 groups were compared. The changes of body temperature, PaO2 during treatment in survivors of both 2 groups and the changes of ACR, Scr, urine β2?macroglobulin after treatment in survivors of both groups were compared. Results There were 2 cases died and 1 case of renal allograft dysfunction in the observation group. There were 2 cases died and 3 case of renal allograft dysfunction in the observation group. No significant difference in clinical efficacy was found between 2 groups (P > 0.05). For survivors, the recovery time of body temperature in the observation group was significantly shorter than that in the control group. From 16 hours until 4 days after treatment, the body temperature in the observation group was significantly lower than that in the control group (P<0.05), the recovery time of PaO2 in the observation group was significantly shorter than that in the control group. From 2 days until the end of statistics after treatment, PaO2 in the observation group was significantly lower than that in the control group (P<0.05). ACR, Scr, urine β2?macroglobulin were significantly increased in all survivors (P < 0.05). There were no significant differences between 2 groups at every time point (P > 0.05). Conclusion Methylprednisolone can decrease body temperature and increase PaO2 in patients with pulmonary infection after renal transplantation rapidly, with no effects on reducing the mortality and renal allograft dysfunction, and the middle?time renal function.

Objective To observe the clinical effect of mechanical perfusion preservation kidney transplantation in donor after cardiac death (DCD),and to explore the effect of mechanical perfusion preservation of DCD on renal function recovery.Methods The clinical data of 186 patients undergoing DCD kidney transplantation from January 2012 to December 2016 were retrospectively analyzed.Sixty-eight DCD donor's kidneys were preserved by LifePortpreservation (low temperature mechanical perfusion group),118 DCD donor's kidneys were preserved by static low temperature preservation (static low temperature preservation group).The renal function recovery,the incidence of primary non-function,delayed graft function and infection,and the survival rate of patients and renal grafts were analyzed.Results There was no significant difference between the two groups in gender,age,hemodialysis ratio,dialysis time,BMI,warm ischemia time and cold ischemia time (P＞0.05).There was significant difference in creatinine value between the two groups at 1st week (P＜0.05),but there was no significant difference in creatinine at 3rd,6th,12th,24th and 36th month (P＞0.05).There was significant difference in the incidence of DGF between two groups (P＜0.05),but no significant difference in the incidence rate of PNF,AR and infection,and the survival rate of patient and renal graft between two groups (P＞0.05).There was no significant difference in 1-and 3-year survival rate of the recipients and transplanted kidney between the two groups (P＞0.05).Conclusion LifePort can significantly reduce the incidence of DGF as compared with static cold preservation.The resistance index and perfusion flow of the LifePort have important significance to assess the renal quality.

Objective To evaluate the effect of living-related donor renal transplantation with mild renal arterial stenosis upon the early renal function and postoperative complications of the recipients. Methods Clinical data of 1 4 donors and recipients undergoing living-related donor renal transplantation with mild renal arterial stenosis and 50 donors and recipients receiving standard living donor renal transplantation from healthy relatives were retrospectively analyzed. The levels of serum creatinine (Scr ) in the donors were statistically compared between two groups. The serum levels of Scr at postoperative 1 ,3 and 6 months in the recipients were statistically compared between two groups. The survival rate of kidney graft,and the incidences of delayed graft function (DGF),acute rejection and pulmonary infection were compared between two groups. Results Postoperative Scr levels of the donors did not significantly differ between two groups(all P>0. 05 ). The Scr levels of the recipients at postoperative 1 ,3 and 6 months did not significantly differ between two groups (all P>0. 05 ). The survival rate of kidney graft,and the incidences of DGF,acute rejection and pulmonary infection in the recipients did not significantly differ between two groups (all P >0. 05 ). Conclusions Living-related donor renal transplantation with mild renal arterial stenosis exerts no significant effect upon renal function and postoperative complication in the recipients,who are eligible for the donors for renal transplantation.

Objective To investigate the effects and mechanisms of hypoxia on the contraction of mesen-teric arteries induced by phenylephrine (PE) in guinea pig. Methods Pressure myograph system was used to study the effects of 20, 40 and 60 min hypoxia (mixed with 95% CO2 and 5% O2) on the constriction induced by PE in acutely separated mesenteric artery (300 ~ 400 μm) of guinea pig. Results PE (0.1 ~ 100 μmol/L) caused the contractions of the mesenteric arteries in guinea pig in a concentration-dependent way . Hypoxia de creased the pH value of perfusion fluid from 7.4 to 6.3. Hypoxia significantly inhibited PE-induced vasocon-striction, and the inhibition was hard to recover after reoxygenation. Hypoxia inhibited PE-induced vasoconstric-tion in a time-dependent way , with the inhibition rate reduced in the sequence of inhibition duration of 60 , 40 and 20 min. When its value was decreased to 6.3 , the perfusion fluid even inhibited PE-induced vasoconstric tion. Conclusion Hypoxia can inhibit PE-induced vasoconstriction in the mesenteric arteries of guinea pig in a time-dependent way. The mechanism may have something to do with the change of pH.

BACKGROUND:Studies have found that alprostadil can inhibit platelet aggregation, relax vascular smooth muscle, diastole peripheral blood vessels and thereby improving peripheral circulation. OBJECTIVE:To further verify whether alprostadil can promote the early recovery of renal function of renal transplantation recipients. METHODS:Total y 125 patients in the alprostadil group received intravenous infusion of 20μg alprostadil daily, and then compared with the 115 patients in the unused alprostadil group in the same time. The urine volume, serum creatinine and the creatinine clearance were compared between two groups;blood flow resistance-indexes, as wel as the incidences of delay recovery of renal function and acute rejection were detected under color doppler ultrasound. RESULTS AND CONCLUSION:The urine volume and creatinine clearance in the alprostadil group were significantly higher than those in the unused alprostadil group;while the serum creatinine and the blood flow resistance-indexes were lower than the unused alprostadil group. The incidence of delay recovery of renal function in the alprostadil group was 7.2%which was significantly lower than that in the unused alprostadil group (P<0.01);there was no significant difference in the incidence of acute rejection between two groups. The findings suggest that the administration of alprostadil in renal transplantation recipients during the early stage of kidney transplantation can accelerate the recovery of the renal function and can promote the early rehabilitation after renal transplantation.

[Objective]To investigate the effect of proximal femoral intramedullary nail with spiral blade for the treatment of femoral peritrochanteric fractures with femoral shaft fractures.[Method]From January 2002 to October 2006,21 patients of femoral peritrochanteric fractures with femoral shaft fractures were treated by minimal invasive technique with proximal femoral intramedullary nail and spiral blade.[Result]All 21 patients were followed up from 9 months to 5 years,with an average of 13 months,fractures healed in all patients.There was no nail and screw broken or loosening.The hip and knee joints of ingived limbs retained good function.[Conclusion]It is a good internal fixation operation for treatment of femoral peritrochanteric fractures with femoral shaft fractures(according to the patient's age,the type of fracture and the Singh index of the bone)by using minimal invasive technique with proximal femoral intramedullary nail and spiral blade,the key of treatment is the anatomic reduction of the fractures under minimal invasive surgery.