Objective To investigate the feasibility and clinical experience of kidney transplantation from donors with Marfan syndrome (MFS). Methods Clinical data of 2 recipients undergoing kidney transplantation from the same MFS patient were retrospectively analyzed and literature review of 2 cases was conducted. Characteristics and clinical diagnosis and treatment of kidney transplantation from MFS patients were summarized. Results The Remuzzi scores of the left and right donor kidneys of the MFS patient during time-zero biopsy were 1 and 2. No significant difference was observed in the renal arteriole wall compared with other donors of brain death and cardiac death. Two recipients who received kidney transplantation from the MFS patient suffered from postoperative delayed graft function. After short-term hemodialysis, the graft function of the recipients received the left and right kidney began to gradually recover at postoperative 10 d and 20 d. After discharge, serum creatinine level of the recipient received the left kidney was ranged from 80 to 90 μmol/L, whereas that of the recipient received the right kidney kept declining, and the lowest serum creatinine level was 232 μmol/L before the submission date (at postoperative 43 d). Through literature review, two cases successfully undergoing kidney transplantation from the same MFS donor were reported. Both two recipients experienced delayed graft function, and then renal function was restored to normal. Until the publication date, 1 recipient has survived for 6 years, and the other recipient died of de novo cerebrovascular disease at postoperative 2 years. Conclusions MFS patients may serve as an acceptable source of kidney donors. However, the willingness and general conditions of the recipients should be carefully evaluated before kidney transplantation. Intraoperatively, potential risk of tear of renal arterial media should be properly treated. Extensive attention should be paid to the incidence of postoperative complications.

Objective To analyze the correlation between T lymphocyte subsets,neutrophil/lymphocyte ratio(NLR),procalcitonin(PCT)and the severity of sepsis.Methods A prospective research method was adopted.A total of 78 sepsis patients admitted to the department of intensive care medicine of Zibo Central Hospital from January 2021 to December 2022 were selected as the research subjects.Patients were divided into a septic shock group(37 cases)and a sepsis group(41 cases)based on the severity of their condition,with 40 healthy examinees from our hospital as the healthy control group.Using flow cytometry to measure the levels of CD4+ T lymphocytes count(CD4+ T)and CD8+ T lymphocytes count(CD8+ T)in three groups of subjects,calculate the CD4+ T/CD8+ T lymphocyte ratio(CD4+ T/CD8+ T)and NLR.The levels of PCT and interleukin-6(IL-6)were measured using electrochemiluminescence immunoassay,and the levels of C-reactive protein(CRP)were measured using immunoassay turbidimetry.Acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 hours was recorded for the two groups of patients,and the differences in lymphocyte subsets and various inflammatory indicators were compared between the groups.Pearson correlation analysis was used to analyze the correlation between various indicators and APACHEⅡscore.Results The CD4+ T,CD8+ T,and CD4+T/CD8+T levels in the septic shock and sepsis groups were significantly lower than those in the healthy control group[CD4+ T(×106/L):168.27±76.68,266.08±131.57 vs.789.60±173.78,CD8+ T(×106/L):156.50±68.37,205.81±75.60 vs.636.42±90.59,CD4+ T/CD8+ T:1.09±0.39,1.27±0.34 vs.1.44±0.38,all P<0.01],NLR,PCT,CRP and IL-6 were significantly higher than those in the healthy control group[NLR:25.85±11.62,15.94±8.72 vs.2.68±1.31,PCT(μg/L):21.82±15.28,9.09±4.96 vs.0.13±0.10,CRP(mg/L):158.65±62.33,106.97±51.49 vs.6.48±2.08,IL-6(ng/L):1 344.64±899.21,245.31±176.99 vs.3.25±1.83,all P<0.01].The APACHEⅡscore in the septic shock group was significantly higher than that in the sepsis group(32.00±1.00 vs.22.01±1.09,P<0.05).Correlation analysis showed that the levels of CD4+ T,CD8+ T,CD4+ T/CD8+ T in two groups of sepsis patients were negatively correlated with the APACHEⅡscore(r values were-0.571,-0.506,and-0.555,respectively,all P<0.01),while the levels of NLR,PCT,CRP,and IL-6 were positively correlated with the APACHEⅡscore(r values were 0.711,0.709,0.777,and 0.707,respectively,all P<0.01).Conclusions As the levels of T lymphocyte subsets decrease,inflammatory indicators like NLR and PCT rise,indicating a more severe sepsis condition.Therefore,T lymphocyte subsets and levels of various inflammatory indicators can serve as markers for evaluating the severity of sepsis.

Objective To investigate the mechanism of Xiaochengqi decoction(XCQD)in the treatment of acute pancreatitis(AP)based on network pharmacology and molecular docking.Methods Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP)was used to screen the active components of Rhubarb-Trifoliate-Magnolia officinalis and Swiss Target Prediction(STP)to predict the drug targets.The relevant targets of AP were screened in the databases of DrugBank,GeneCards,Online Mendelian Inheritance in Man(OMIM),Therapeutic Target Database(TTD)and Pharmacogenomics Knowledge Base(PharmGKB).The target protein interaction network was constructed by String software,and the network was drawn by Cytoscape and analyzed by topology,respectively.R3.6.2 was used for Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis.Autodock 4.2.6 and Vina were used for molecular docking.Results A total of 124 related therapeutic targets were obtained.Eleven targets,including retinoblastoma 1(RB1),protein kinase B(PKB),cyclin D1(CCMD1),v-myc avian myelocytomatosis viral oncogene homolog(MYC),estrogen receptor1(ESR1),reticuloendotheliosis virus oncogene homolog A(RELA),activator protein-1(AP-1),p53,mitogen-activated protein kinases(MAPK 1,3 and 14),were found to be the core targets by network topology analysis.GO and KEGG enrichment analysis showed that XCQD could play a role in the treatment of AP by regulating the apoptosis,proliferation and differentiation of pancreatic cells,inhibiting oxidative stress,etc,among which,phosphatidylinositol 3 kinase-protein kinase B(PI3K-Akt)signaling pathway is the most important one.In terms of molecular docking,Naringenin-MAPK1,Naringenin-MAPK3,Naringenin-PKB,Nobiletin-p53,Nobiletin-AP-1,Luteolin-CCND1,Luteolin-RELA,Tetramethoxyluteolin-MAPK14,Aloe-emodin-MYC and catechin-ESR1 showed good docking activity due to their low free energy.Conclusion By using network pharmacology and molecular docking,it was confirmed that XCQD had the characteristics of multi-channel and multi-target action and revealed the material basis and mechanism in the treatment of AP,which provided references for the extensive application of classical prescriptions and the theoretical basis for the later basic research.

Objective:Objective To explore the clinical values of next-generation sequencing (NGS) in bacterial 16S rRNA region and fungal ITS region for diagnosing and treating urinary tract infection (UTI) in renal transplant recipients.Methods:A total of 90 mid-stream clean-catch urine samples were collected from renal transplant recipients who were diagnosed with UTI at Hospital from January 2017 to December 2019. Each sample was equally divided and tested via NGS method and traditional urine culture separately. The results of pathogen test and detection rate were analyzed and compared.Results:And 21/90 sample were considered to be contaminated due to the identification of three or more kinds of microorganisms by culture. And among the remaining 69 samples, 36 (52.17%) cases tested positive by 16S rRNA sequencing, 25 (36.23%) positive by urine bacterial culture; meanwhile, 34(49.28%) tested positive by ITS sequencing and 4(5.80%) positive by urine fungal culture.Conclusions:The detection rate of both bacteria and fungi in NGS microorganism testing is higher than that in traditional urine culture ( P< 0.05). For renal transplant recipients with UTI, NGS microorganism testing is an effective supplement for traditional urine culture. Improving the detection rate and accuracy of etiology may enable an optimization of individualized treatment.

Objective To evaluate the effect of global end diastolic volume index (GEDVI) on fluid resuscitation in elderly patients with septic shock. Methods A prospective randomized controlled trial (RCT) was conducted. Septic shock patients over 65 years admitted to intensive care unit (ICU) of Shandong Province, Zibo Central Hospital from January 2013 to December 2015 were enrolled. The patients were randomly divided into control group and observation group, 20 cases in each group. In accordance with the guidelines for the treatment of septic shock, early goal-directed therapy (EGDT), rehydration in the control group was treated with the guide of central venous pressure (CVP); observation group was received pulse indicator continuous cardiac output (PiCCO) monitoring, and rehydration was treated according to the GEDVI and extravascular lung water index (EVLWI), i.e. GEDVI was maintained in 650-800 mL/m2, EVLWI was not obviously increased compared with the basic value and without the emphasis of CVP. Initial acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score, sequential organ failure score (SOFA), procalcitonin (PCT), mean arterial pressure (MAP), lactic acid (Lac) and oxygenation index (PaO2/FiO2); serial Lac, central venous to arterial carbon dioxide pressure (Pcv-aCO2), fluid balance, the amount of noradrenaline accumulation, PaO2/FiO2 after 6, 24 and 48 hours resuscitation; mechanical ventilation time, incidence of acute heart failure, ICU hospitalization time and 28-day mortality were recorded. Results There was no significant difference in gender,age, APACHE Ⅱ score, SOFA score, primary disease, infection site and basal PCT, MAP, Lac, PaO2/FiO2 between the two groups. Compared with the control group, 6 hours Lac, Pcv-aCO2 recovery, positive fluid balance, noradrenaline accumulation and PaO2/FiO2 of the observation group showed no significant difference; positive fluid balance 24 hours in the recovery was significantly reduced (mL: 2919.80±986.44 vs. 3991.40±933.53), Pcv-aCO2 significantly decreased [mmHg (1 mmHg = 0.133 kPa): 5.55±1.43 vs. 7.10±2.38], PaO2/FiO2 significantly improved (mmHg: 194.80±28.57 vs. 177.65±23.46), and noradrenaline accumulation was increased significantly (mg: 40.99±20.69 vs. 27.31±19.34) with statistically significant difference (all P < 0.05); the blood level of Lac 48 hours in the recovery was significantly decreased (mmol/L: 1.16±0.89 vs. 1.85±1.01), Pcv-aCO2 (mmHg: 5.35±1.18 vs. 6.70±2.34), and PaO2/FiO2 (mmHg: 215.75±33.84 vs. 190.60±32.89) were further improved, the positive fluid balance was significantly reduced (mL: 3141.55±1245.69 vs. 4533.85±1416.67, all P < 0.05). Compared with the control group, mechanical ventilation time (days: 3.65±1.31 vs. 4.50±1.19), ICU hospitalization time (days: 5.80±1.67 vs. 7.15±2.30) was significantly shorter in the observation group (both P < 0.05), acute heart failure rate was decreased significantly (5.0% vs. 30.0%, P < 0.05), but the 28-day mortality showed no statistical significance (25.0% vs. 40.0%, P = 0.311). Conclusions Compared to the conventional EGDT methods, fluid resuscitation under the guidance of GEDVI in elderly patients with septic shock with less liquid loading, can achieve better oxygenation and reduce heart failure, shorten the duration of mechanical ventilation and ICU stay, and play an important significant guidance for elderly patients' fluid resuscitation with septic shock.

Objective To investigate the effect of concentrated suture fixation in subdermal vascular network flap method for treatment of axillary osmidrosis in reducing postoperative complications,increase the wound dressing effect of comfort.Methods Ninety-six cases of bilateral axillary osmidrosis patients were randomly divided into concentrated suture group (group A) and 8 bandage compression group (group B),48 cases in each group.They were cleared of sweat gland retaining subdermal vascular network skin flap method in treatment of axillary osmidrosis.Group A was treated with concentrated suture fixation after the separation of the subdermal vascular network flap by in situ,group B was treated by routine compression bandage fixation after the separation of the subdermal vascular network flap.Observation of subcutaneous hematoma,infection,necrosis of skin after operation and understood dressing comfort.To observe the peculiar smell and axillary scar,operation area 6 months postoperative growth.Results The postoperative observation:group A subcutaneous hematoma complication rate was lower in group B,the incidence of 1.04％ (1/96) vs.19.79％ (19/96),the difference was statistically significant (P ＜ 0.01).Group A postoperative dressing comfort satisfaction rate was 93.75％ (45/48),group B po or comfort,satisfaction rate was only 10.42％(5/48),the difference had statistically significant (P ＜ 0.01).After 6 months of postoperative,the total efficiency of two groups were 100.00％,no significant difference (P ＞ 0.05).Group A district scar formation rate was higher than that in group B [3.12％(3/96) vs.21.88％(21/96)] (P ＜ 0.05).The armpit hair and sweat in the two groups was significantly reduced,there was no significant difference (P ＞ 0.05).Conclusion Concentrated suture fixation method in the treatment of axillary osmidrosis by subdermal vascular network is a reliable fixation of the axillary free after the subdermal vascular network flap,and have flap high healing rate,scar,low rate of complications; postoperative dressing is simple,comfortable,living freely,overall is better than 8 bandage compression method.

Objective To analyze the correlations between acute respiratory distress syndrome ( ARDS) and extravascular lung water(EVLW),tumor necrosis factor alpha (TNF-α),E-selectin,vasostatin-2.To discuss the value of EVLW, TNF-α, E-selectin and vasostatin-2 in evaluating the severity of ARDS and prognosis of this disease . Methods There are thirty-six patients with ARDS were selected .According to the level of EVLWI shown by pulse indicator continuous cardiac output ( PiCCO) monitor,they were divided into the two groups:EVLWI≥14mL/kg group (n=18) and EVLWI<14mL/kg group(n=18).To monitor and record the levels of EVLWI ,PVPI,CI,ITBV,record oxygenation index ,calculate APACHEII score .The levels of TNF-α,E-selectin and vasostatin-2 in serum were meas-ured by ELISA.Results In EVLWI≥14mL/kg group,the APACHEⅡscore was (23.93 ±4.44),28-day mortality was 61.1%,the stay time in ICU was (19.05 ±4.0) d,which were higher than those in EVLWI <14mL/kg group [APACHEII score (18.58 ±3.66),28-day mortality(27.8%),the stay time in ICU(14.35 ±3.39) d](t=3.941,χ2 =4.050,t=3.797,all P<0.01).And the levels of TNF-α[(85.28 ±18.25)μg/L]and E-selectin[(74.07 ± 14.57)μg/L]in serum were higher than in EVLWI <14mL/kg group[TNF-α(63.27 ±20.28)μg/L,E-selectin (40.99 ±16.35)μg/L](t=3.422,5.847,all P<0.01).The oxygenation index of EVLWI≥14mL/kg group was (122.86 ±25.45),which was lower than that in EVLWI <14mL/kg group[(156.77 ±37.58)](t=-3.170,P<0.01).In the two groups of patients still alive within 28 days,after active treatment for 72 hours,the level of EVLWI was significantly lower than before in these 20 patients(Z=-0.392,P<0.01),oxygenation index was significantly higher than before(Z=-3.845,P<0.01),and the levels of TNF-αand E-selectin were significantly lower than before(t=7.194,4.025,all P<0.01).But 16 patients in the death group,after active treatment for 72 hours,the levels of EVLWI ,TNF-α,E-selectin and oxygenation index had no significant change ,there was no statistically signifi-cant difference(P>0.05).EVLWI had positive correlation with PVPI,TNF-αand E-selectin (r=0.605,0.649, 0.549,all P<0.01),and EVLWI had a negative correlation with oxygenation index (r=-0.715,P<0.01).Results showed no difference in vasostatin-2 between the two groups(P>0.05).Conclusion There were significant correla-tions between EVLWI and TNF-α,E-selectin in patients with ARDS.The levels of EVLWI,TNF-α,E-selectin were higher,and the mortality rate was higher,the the stay time in ICU was longer.The levels of EVLWI,TNF-αand E-selectin can provide a good reference value to the judgement of the severity of disease and prognosis in patients with ARDS.The level of vasostatin-2 had no correlation with EVLWI .

OBJECTIVETo evaluate the influence of major histocompatibility complex class I chain-related gene A (MICA) antibodies on acute rejection (AR) and renal function in early stage after renal transplantation.

METHODSA total of 197 renal transplant candidates admitted in Nanfang Hospital in 2009-2010 were enrolled in this study. MICA antibodies and their specificity were detected in all the patients, and 139 patients were followed up for early acute rejection (AR) and graft function after transplantation.

RESULTSMICA antibodies were positive before transplantation in 45 candidates (22.84%). Eleven specific MICA antibodies were identified, among which the frequency of MICA019 antibody (65.7%) was significantly higher than that of MICA015 (8.6%) and MICA017 (8.6%) (P<0.01). Eighteen patients with positive MICA antibodies were single-specific and 17 were polyspecific (51.4% vs 48.6% ). Of the 139 patients undergoing renal transplantation, 39 developed early AR (28.1%). Of the 45 candidates positive for MICA antibodies, 38 received renal transplantation and early AR occurred in 14 of them (36.8%); 101 of 152 candidates negative for MICA antibodies underwent renal transplantation, and 25 experienced early AR (24.8%).

CONCLUSIONMICA019 antibody is a frequent MICA antibody possibly due to the high frequency MICA019 gene in Chinese population.

Adult ; Antibodies ; immunology ; Antibody Specificity ; Female ; Graft Rejection ; immunology ; Graft Survival ; immunology ; Histocompatibility Antigens Class I ; genetics ; immunology ; Humans ; Kidney Transplantation ; Male ; Middle Aged

ObjectiveTo study the curative effect of axillary osmidrosis,that incision in armpit wrinkle,orthoptic cut off the gland to thick skin flap.MethodsCollected double-sided axillary osmidrosis 163 patients,all of them accepted armpit wrinkle incision,the scope of surgical operation super the armpit hair distribute 1 cm,swelling anaesthesia,orthoptic cut off the armpit organization 5 mm under skin included apocrine sweat gland,kept the operation scope to vessel net flap under skin.Hematischesis thoroughly used a double pole electricity hemostasis,kept drainage after operation,bandaged in pressure,took out sutures after 9 days.The foul smell standard referenced the Tung-Chain standard of axillary osmidrosis curative effect evaluation.ResultsThree hundred and twenty armpits (98.16％,320/326) were cure,6 armpits (1.84％,6/326) were excellence.The armpit hair variety:obvious reduce 322 armpits(98.77％,322/326),general reduce 4 armpits(1.23％,4/326).Perspire condition:obvious reduce 324 armpits(99.39％,324/326),improve but no obvious reduce 2 armpits ( 0.61％,2/326).The average surgical operation recovery time was about 9 days.Complication:necrosis on the edge of the skin was 8 armpits,scar formation on the incision was 3 armpits,hematoma was 1 armpit,shoulder joint limitation of activity was 0 armpit.ConclusionThe method of axillary osmidrosis treatment useing thick skin flap in armpit wrinkle,which has extermination foundation of anatomy and pathology,which can cause axillary osmidrosis,this operation is simple,curative effect is credible,the wound is small,complication is little etc,utmost matching the principle of orthopedic surgery,worthy of clinical application.

ObjectiveTo assess the effect of modified minimally-invasive transverse-vertical epicanthoplasty in double-eyelid plastic with three points at the same period.Methods87 cases with mild or moderate epicanthus and oriental eyelid were involved in our research.Epicanthoplasty was performed based on the principle of transversevertical plasty.The curvilinear incision of epicanthoplasty was made between the desired point of the new medial canthus and the lower lacrimal point,the malpositioned orbicularis oculi muscle excised after skin undermining,the superficial head of the medial canthal tendon plicated or anchored to the lateral nasal aponeurosis and the incision closed after skin redraping.Double-eyelid plastic with three points was performed as usual,however,the incision of eyelid plastic was connected with the incision of epicanthoplasty by skin tunnel in which a strip of orbicularis oculi muscle was excised.Results87 cases were followed-up for 3 to 24 months.The cosmetic results of the new medial canthi were satisfactory with new figure and inconspicuous scar.The contours of the double eyelids were natural.No incisional scar presented between the medial canthi and the upper eyelids.No recurrence of epicanthus was observed.ConclusionThe modified mini-incisional transverse-vertical epicanthoplasty together with double-eyelid plastic with three points is a simple and effective feasible surgical approach for correction of epicanthus and oriental eyelid.