Background::The calcineurin inhibitor (CNI)-based immune maintenance regimen that is commonly used after renal transplantation has greatly improved early graft survival after transplantation; however, the long-term prognosis of grafts has not been significantly improved. The nephrotoxicity of CNI drugs is one of the main risk factors for the poor long-term prognosis of grafts. Sirolimus (SRL) has been employed as an immunosuppressant in clinical practice for over 20 years and has been found to have no nephrotoxic effects on grafts. Presently, the regimen and timing of SRL application after renal transplantation vary, and clinical data are scarce. Multicenter prospective randomized controlled studies are particularly rare. This study aims to investigate the effects of early conversion to a low-dose CNI combined with SRL on the long-term prognosis of renal transplantation.Methods::Patients who receive four weeks of a standard regimen with CNI + mycophenolic acid (MPA) + glucocorticoid after renal transplantation in multiple transplant centers across China will be included in this study. At week 5, after the operation, patients in the experimental group will receive an additional administration of SRL, a reduction in the CNI drug doses, withdrawal of MPA medication, and maintenance of glucocorticoids. In addition, patients in the control group will receive the maintained standard of care. The patients’ vital signs, routine blood tests, routine urine tests, blood biochemistry, serum creatinine, BK virus (BKV)/cytomegalovirus (CMV), and trough concentrations of CNI drugs and SRL at the baseline and weeks 12, 24, 36, 48, 72, and 104 after conversion will be recorded. Patient survival, graft survival, and estimated glomerular filtration rate will be calculated, and concomitant medications and adverse events will also be recorded.Conclusion::The study data will be utilized to evaluate the efficacy and safety of early conversion to low-dose CNIs combined with SRL in renal transplant patients.Trial registration::Chinese Clinical Trial Registry, ChiCTR1800017277.

Objective: To explore the imaging manifestations of thoracic CT in patients with Gaucher disease (GD) in order to improve the diagnostic ability. Methods: Forty-three patients with GD were collected from May 2003 to October 2018 in Beijing Children′s Hospital, including 25 males and 18 females, aged from 10 to 34 years, with an average age of (21±6) years. All the patients underwent routine chest CT examinations, and analysis and description of pulmonary interstitial and parenchyma imaging manifestations were performed. Results: Among the 43 GD patients, 20 patients presented with abnormal chest CT findings: 10 showed diffuse interlobular septa thickening, mainly distributed in the lower lobes of both lungs; 5 showed ground glass opacities in a single or multiple lobes of the lung. There were 2 cases with small nodules, which showed round-like nodules of different sizes. One case had pulmonary fibrosis, especially in the left upper lobe. Other manifestations included bullae in 3 cases,localized pleural thickening in 2 cases, pneumothorax in 1 case; pulmonary hypertension in 1 case and thymus enlargement in 12 cases. Most of the GD patients had pulmonary lesions between 10 and 14 years old. The signs of interlobular septa thickening and thymus enlargement were common, with 5 cases in each age group. Conclusions GD involves the lungs in half of the patients. The manifestations of the lungs are diverse, and most of them are diffuse interstitial lesions. The main signs are interlobular septal thickening and ground glass opacity, which are consistent with the pathology of Gaucher cell infiltration.But the signs are not specific, the diagnosis should be made in combination with the clinical information, and attention should be paid to the differentiation of lung infiltration caused by other diseases.

Objective To explore the effects of hyperbaric oxygen (HBO) on the incidence of complications and treatment efficacy following decompressive craniectomy(DC) in severe traumatic brain injury.Methods A total of 160 patients who underwent DC for severe traumatic brain injury from January 2010 to December 2014 in the Neurosurgery Department of Yantai Yuhuangding Hospital were chosen for the study.The subjects were divided into the HBO group (86 Patients) and the routine treatment group (74 patients) in accordance with different treatment methods.Incidence of complications,changes in EEG at different time points after surgery,the levels of transforming factor-β1 (TGF-β1) and myelin basic protein (MBP) in cerebrospinal fluid,scores of Glasgow Coma Scale as well as scores of Modified Rankin Scale 6 months after surgery were compared between the two groups.Results Following DC in severe traumatic brain injury,the rates of cerebral herniation (31.4％),postsurgical epilepsy (10.5％) and hydrocrania (11.6％) in the HBO group were all obviously decreased(47.3％,23.0％,24.3％),as compared with those of the control group,and statistical significance could be seen,when comparisons were made between the 2 groups (P ＜ 0.05).The incidence of subdural effusion in the HBO group was 32.6％,while that of the routine treatment group was 41.9％,and there was no statistical significance,when comparisons were made between the 2 groups (P ＞ 0.05).In the HBO group,the levels of TGF-β 1 and MBP in the cerebrospinal fluid 14 and 21 days after surgery were significantly decreased,as compared with those of the routine treatment group.The EEG and GCS scores in the HBO group were significantly improved,1 and 3 months after surgery,as compared with those of the routine treatment group.The scores of the modified Rankin Scale of the HBO group,which were obtained 6 months after surgery,were significantly higher than those of the routine treatment group,and statistical significance could be noted,when comparisons were made between the 2 groups (P ＜ 0.05).Conclusions Following decompressive cranioectomyin,HBO in the treatment of severe traumatic brain injury could obviously decrease the rates of cerebral herniation,postsurgical epilepsy and hydrocrania.HBO could also substantially improve EEG and decrease levels of TGF-β 1 and MBP,14 and 21 days after surgery,and improve the prognosis of the patients.

Objective To explore the effects of hyperbaric oxygen (HBO) on the incidence of complications and treatment efficacy following decompressive craniectomy(DC) in severe traumatic brain injury.Methods A total of 160 patients who underwent DC for severe traumatic brain injury from January 2010 to December 2014 in the Neurosurgery Department of Yantai Yuhuangding Hospital were chosen for the study.The subjects were divided into the HBO group (86 Patients) and the routine treatment group (74 patients) in accordance with different treatment methods.Incidence of complications,changes in EEG at different time points after surgery,the levels of transforming factor-β1 (TGF-β1) and myelin basic protein (MBP) in cerebrospinal fluid,scores of Glasgow Coma Scale as well as scores of Modified Rankin Scale 6 months after surgery were compared between the two groups.Results Following DC in severe traumatic brain injury,the rates of cerebral herniation (31.4％),postsurgical epilepsy (10.5％) and hydrocrania (11.6％) in the HBO group were all obviously decreased(47.3％,23.0％,24.3％),as compared with those of the control group,and statistical significance could be seen,when comparisons were made between the 2 groups (P ＜ 0.05).The incidence of subdural effusion in the HBO group was 32.6％,while that of the routine treatment group was 41.9％,and there was no statistical significance,when comparisons were made between the 2 groups (P ＞ 0.05).In the HBO group,the levels of TGF-β 1 and MBP in the cerebrospinal fluid 14 and 21 days after surgery were significantly decreased,as compared with those of the routine treatment group.The EEG and GCS scores in the HBO group were significantly improved,1 and 3 months after surgery,as compared with those of the routine treatment group.The scores of the modified Rankin Scale of the HBO group,which were obtained 6 months after surgery,were significantly higher than those of the routine treatment group,and statistical significance could be noted,when comparisons were made between the 2 groups (P ＜ 0.05).Conclusions Following decompressive cranioectomyin,HBO in the treatment of severe traumatic brain injury could obviously decrease the rates of cerebral herniation,postsurgical epilepsy and hydrocrania.HBO could also substantially improve EEG and decrease levels of TGF-β 1 and MBP,14 and 21 days after surgery,and improve the prognosis of the patients.