Objective To explore the influencing factors and treatment strategies of long-term survival after simultaneous pancreas and kidney transplantation (SPK ) .Methods One case of long-term post-SPK survival was reviewed and its influencing factors were analyzed along with the relevant literature .Results At 10 years post-SPK ,the patient lost transplanted kidney due to rejection and underwent secondary kidney transplantation . The transplanted pancreas functioned well and has survived for more than 18 years .Conclusions Strict preoperative screening ,adopting mature surgical approaches ,aggressive managements of various perioperative complications ,strengthening of health education of recipients ,improving of compliance and long-term regular follow-ups are conducive for enhancing long-term survival of recipients and grafts of SPK .

Objective To investigate the clinical outcome of single kidney transplantation from pediatric donors and to explore the application criteria.Methods The clinical data of 14 recipients undergoing renal transplantation from October 2006 to October 2016 were retrospectively analyzed.All the recipients received primary kidney transplantation from pediatric donor and the renal artery was anastomosed with external iliac artery.Based on the length of the kidney donor,the recipients were divided into two groups as group A (length beyond 6 cm) and group B (length 5-6 cm).The clinical effect and complications of the 14 recipients,the survival of the recipients and grafts,the recovery of renal function,the change of the renal length and the postoperative complications were compared between the two groups.Results The renal length in group A (n =7) was (7.5 ± 1.2) cm,and (5.7 ± 0.1) cm in group B (n =7).During the follow up period,all renal grafts and recipients survived.No significant difference was observed between two groups in renal graft function evaluated by serum creatinine and estimated glomerular filtration rate (eGFR) at 7th day,14th day,1st,2nd,3rd and 6th month postoperatively,P＞0.05.The length of transplanted kidney increased after operation in both groups,with results of 9.9 ± 0.6 cm in group A and 10.4 ± 1.5 cm in group B (P＞0.05),respectively,at 2nd month post-transplantation.Delayed graft function (DGF) occurred in 2 cases of group A and 1 case of group B.Seven cases developed proteinuria (50.0％),including 2 cases in group A (28.6％) and 5 cases in group B (71.4％).Four cases suffered hematuria (28.6％),including 2 cases in group A (28.6％) and 2 cases in group B (28.6％).One recipient in group B suffered acute rejection.No vascular embolization,urine leakage,pulmonary infection and other complications were observed in all the recipients.Conclusion The length beyond 5 cm is acceptable for single pediatric kidney donor for adult recipients with a promising clinical outcome in short-term.However,the high incidence of proteinuria and hematuria remains obstacle,and the long-term outcome needs further exploration.

Background and purpose:The third generation of aromatase inhibitors (AI) in postmenopausal hormone receptor-positive patients is the routine treatments in endocrine therapy. The 500 mg fulvestrant showed clini-cal beneifts in patients with previous AI treatment. This study aimed to access the effcacy and safety of 500 mg fulves-trant in estrogen receptor (ER) positive postmenopausal patients who had previous AI treatments with locally advanced and metastatic breast cancer.Methods:This study retrospectively analyzed the clinical data from 188 post-AI ER positive and (or) progesterone receptor (PR)-positive locally advanced and metastatic breast cancer patients treated with 500 mg fulvestrant in Fudan University Shanghai Cancer Center from Jul. 2011 to Dec. 2015. Primary end point was progression-free survival (PFS). Secondary end points were objective response rate (ORR), clinical beneift rate (CBR) and safety proifle.Results:After the median follow-up of 11.3 months, median PFS was 5.9 months (95%CI: 4.2-7.5), CBR was 40.0% and ORR was 3.4%. COX proportional hazards regression analysis indicated that PFS was correlated with the number of metastatic sites (HR=1.92, 95% CI: 1.2-2.9,P =0.002) and previous lines of chemotherapy (HR=1.52, 95%CI:1.0-2.1,P=0.022). Six patients stopped the treatment for intolerable adverse events.Conclusion:The treatment of 500 mg fulvestrant has a favorable effcacy and safety in treatment of post-AI ER positive postmenopausal patientswith metastatic breast cancer.

Objective To investigate the clinical characteristics and strategies of early stage antibody-mediated rejection after renal transplantation.Method The clinical data of early stage AMR of 3 cases of renal transplantation,and 1 case of pancreas transplantation after renal transplantation were retrospectively analyzed.(1) The case 1 was diagnosed as having early severe acute AMR.Serum creatinine was increased,urine volume rapidly reduced,the blood flow of transplanted kidney reduced on the postoperative day 8;the positive rate of panel reactive antibody (PRA) class Ⅰ and Ⅱ was 74.6％,and 2.7％ respectively on the postoperative day 12.Biopsy showed widely ischemia and local bleeding in transplanted kidney and DSA showed anti-B62 mean fluorescence intensity (MFI) increased to 6800 on the postoperative day 14.(2) The case 2 was diagnosed as having early mild acute AMR.The positive rate of PRA class [and Ⅱ was 65.6％ and 78.9％ respectively.DSA Ⅰ was positive,anti A11 MFI was 3059,and DSA Ⅱ was negative on the postoperative day 13.Biopsy showed mild ischemia reperfusion injury in transplanted kidney on the postoperative day 21.(3) The case 3 was diagnosed as having early severe chronic AMR,and the recipient received pancreas transplantation 1 year after kidney transplantation.Eight months after pancreas transplantation,DSA for pancreas donor was detectable,anti A2 MFI was 7514,anti B46 MFI was 3 159 and anti DQ7 MFI was 1 503.(4) The case 4 was diagnosed as having early mixed rejection.Serum creatinine was elevated on the postoperative day 8;PRA testing showed that the positive rate of class Ⅰ and Ⅱ was 3％ and 70％ respectively,DSA was positive,and anti DR16 MFI was 15 170 on the postoperative day 14;transplanted kidney biopsy showed acute mixed rejection on the postoperative day 16.Result Case 1 and case 3 were not diagnosed and treated in time and graft loss developed.Case 2 and case 4 were functionally recovered after combined treatment of plasmapheresis,IVIG and bortezomib.Conclusion Diagnosis of antibody-mediated rejection is based on transplant graft dysfunction,positive DSA and graft biopsy.Early diagnosis,early treatment and combined therapy can improve the curative rate of AMR.

BACKGROUND: Compared with the metal screws, absorbable screws have more obvious advantages, such as does not have to conduct internal fixation removal, non-metal ic components, no influence on the magnetic resonance imaging of patients after implantation, relatively simple operations, namely dril ing-tapping-screws fixation, more in line with the principles of minimal y invasive in orthopedics. OBJECTIVE: To investigate the biomechanical characteristics of absorbable screw fixation in repair of simple lateral mal eolus fractures by means of finite element technology. METHODS: The three-dimensional model of simple lateral mal eolus fractures and absorbable screw model were established, and then fixed according to standard orthopedic surgical techniques. The reference load when the load bearing of fibulotalar joint reaching the peak value in a normal adult gait cycle was loaded. The stress distribution and displacement of fibula and absorbable screws were analyzed. RESULTS AND CONCLUSION: There were total y 38 542 units, 8 790 nodes in the single screw fixation model. When the articular facet of lateral mal eolus loading 300 N, the maximum stress of screws was 89.35 MPa, the maximum displacement was 0.5 mm, the maximum displacement of the distal fracture was 0.5 mm. When the articular facet of lateral mal eolus loading 450 N, the maximum stress of screws was 152.58 MPa, the maximum displacement was 0.59 mm, the maximum displacement of the distal fracture was 0.77 mm. There were total y 43 115 units, 9 496 nodes in the double screws fixation model. When the articular facet of lateral mal eolus loading 300 N, the maximum stress of screws was 38 MPa, the maximum displacement was 0.44 mm, the maximum displacement of the distal fracture was 0.44 mm. When the articular facet of lateral mal eolus loading 450 N, the maximum stress of screws was 66.68 MPa, the maximum displacement was 0.48 mm, the maximum displacement of the distal fracture was 0.49 mm. The experiment verified the biomechanical feasibility of absorbable screw fixation in repair of simple lateral mal eolus fractures. For simple involving only the lower lateral fibular fracture, absorbable screw fixation is entirely feasible, and usual y requires at least two screws to maintain the stability of the articular surface of the reset.

Objective The use of targeting therapy for the treatment of gastric glandular cancer has been a hot topic in recent years. This study aims to clarify that through what ways the histone deacetylase inhibitor MS-275 completes its selectively killing effect on gastric glandular cancer cell line SGC-7901. Methods SGC-7901 cells and GES-1 cells were respectively cultured for 24h, with(10-100) μmol/L concentrations of MS-275. (1) The survival rate of SGC-7901 cells, GES-1 cells and the normal cells were analyzed by WST-1; (2) The change of the mitochondrial membrane potential in SGC-7901 was estimated by flow cytometry;(3) The expression levels of p21, p27, p57, cyclinB1, cyclinD1 were determined by Western blot and PCR methods. Results (1) MS-275 could decrease the survival rate of SGC-7901 cells, the effect was significantly enhanced with the increasing of the concentration (P<0.05), but MS-275 showed no obvious effect on normal gastric mucosa epithelial cells GES-1; (2) MS-275 treatment could decreased the mitochondrial membrane potential of SGC-7901 cells (P<0.05); (3) MS-275 treatment could increase the relative contents of p21, p27, p57 genes and their protein and, at the same time, decrease the relative contents of CyclinB1 and CyclinD1 (P<0.05). Conclusion MS-275 treatment can selectively kill gastric glandular cancer cells SGC-7901 through several possible ways, such as inducing mitochondrial apoptosis and regulating the expression levels of cell cycle-related genes and proteins.

Objective To evaluate the clinical efficacy and safety of two kinds of uterine artery perfusion chemotherapy plus embolization (UACE) in treating ectopic pregnancy (EP). Methods A single center, randomized, double-blind, controlled clinical trial was carried out at authors hospital. A total of 50 cases of EP patients were randomly and equally divided into the study group (perfusion chemotherapy of MTX and 5-FU plus embolization therapy) and the control group (perfusion chemotherapy of pure MTX plus embolization therapy). After UACE, the serumβ-HCG value, the clinical healing time and the tubal patency rate were determined at different time, and the adverse events were recorded. The results were statistically analyzed by using t test, and χ2 test, and the data were compared between the two groups. Results One patient in both groups was excluded from the study. In the remaining 48 patients, one patient of the control group failed to respond the treatment, so the overall cure rate was 97.9%. The differences in the main effect of treatment method and the time interaction of the serum β-HCG values between the two groups were not statistically significant (P > 0.05), while the difference in the time effect between the two groups was statistically significant (P < 0.05). The clinical healing time of the study group and the control group was (28.57 ± 5.08) days and (26.74 ± 5.57) days respectively, and no statistically significant difference existed between the two groups(P>0.05). The tubal patency rate of the study group and the control group was 76.2%and 78.9%respectively, and no statistically significant difference existed between the two groups (P > 0.05). The adverse events in both groups were mild, and the occurrence of the adverse events in the study group and the control group was 58.3% and 26.1% respectively, and the difference between the two groups was statistically significant (P <0.05). Conclusion Two kinds of interventional methods have the same clinical curative effect. However, the incidence of adverse events in the control group is lower than that in the study group. Therefore, in treating ectopic pregnancy perfusion chemotherapy with MTX only is recommend.

Objective To evaluate the correlation between intracranial hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery(FLAIR) and the degree of the stenosis of internal carotid artery (ICA).The effect of carotid endarterectomy(CEA) on HVS was assessed.Methods A retrospective analysis of MR FLAIR sequence and cerebral-cervical computed tomography angiography(CTA) was performed in 1 total of 491 patients.Of the 491 patients,41 treated with CEA were evaluated using their pre-and post-operative image data.Patients were divided into ICA stenosis group and non-stenosis group according to the CTA imaging findings.The ICA stenosis group was subdivided into unilateral group and bilateral stenosis group.Furthermore,we measured and graded the ICA of the unilateral stenosis group into seven stenotic degrees,they were＜50％(n=40),50％-＜60％(n=15),60％-＜70％(n=17),70％-＜80％ (n=6),80％-＜90％ (n=7),90％-＜100％ (n=23),100％ (n=24),respectively.Chi square test was used to analyze the occurrence rates of HVS between ICA stenosis and non-stenosis group,and between ICA unilateral and bilateral stenosis group,respectively.Spearman rank correlation was performed to evaluate the correlation between the presence of HVS and stenotic degrees of the ICA.For the 41 patients who underwent CEA,pre-and post-operative image data were compared,focusing on the presence or disappearance of the HVS on MR FLAIR imaging.Results HVS on FLAIR images were observed in 81 of 177 patients(45.76％) with ICA stenosis,and in 59 of 314 patients(18.79％) without ICA stenosis.The occurrence rate of HVS was significantly higher in patients with ICA stenosis than those without ICA stenosis (x2=40.40,P＜0.01).There was no statistical significance in the occurrence rates of HVS between ICA unilateral stenosis group and bilateral stenosis group(x2=0.24,P＞0.05).The occurrence rates of HVS of ICA graded as the seven stenotic degrees were 22.00％(8/40),26.67％(4/15),35.29％(6/17),33.33％ (2/6),42.86％ (3/7),69.57％ (16/23),83.33％ (20/24),respectively.There was a significant positive correlation between the occurrence rates of HVS and the degrees of ICA stenosis(r=0.964,P＜0.01).HVS disappeared in 19(86.36％) out of 22 patients with HVS on pre-operative MR images after CEA in The remaining HVS in 3(13.64％) patients was attributed to the failure of completely recanalization of ICA.Conclusions A close relationship exists between HVS and ICA stenosis.The presence of HVS indicates a high probability of the existence of severe ICA stenosis.A further assessment for ICA stenosis is warranted.HVS disappearance after successful CEA indicates that HVS can be a useful marker for the the evaluation of consequence associated with CEA.

Objective To construct the stable stathmin-overexpression SMMC-7721 hepatocellular carcinoma cells and to explore the effect of stathmin-overexpression on the cell proliferation and metastasis in SMMC-7721 cells .Methods By using liposome , Flag-pcDNA3 .1 and Flag-pcDNA3 .1-stathmin plasmid were transfected into SMMC-7721 cells respectively ,the stable Flag-pcD-NA3 .1 expression cells(control group) and the stable stathmin-overexpression cells(experimental group) were established after an-tibiotic resistant gene screening ,and the cell lines were identified by Western Blot .Subsequently ,the cell proliferation was detected by cell count kit(CCK-8) and the soft agar assay ,the apoptosis and cell cycle were determined by the flow cytometry (FCM ) ,and the cell motility and invasion were analyzed by the Transwell assay in vitro .Results The stathmin protein expression of the experi-mental group was significantly increased compared with the control group (0 .76 ± 0 .12 vs .0 .16 ± 0 .05 ,P<0 .05) ,which indicated that the stathmin-overexpression human SMMC-7721 hepatocellular carcinoma cell line was successfully constructed .CCK-8 and the soft agar assay showed that the cell proliferation of the experimental group was higher than that of the control group (0 .29 ± 0 .03 vs .0 .60 ± 0 .05 ,P< 0 .01);additionally ,the apoptotic ratio of the experimental group was decreased compared with the control group[(11 .57 ± 1 .09)% vs .(5 .80 ± 0 .33)% ,P<0 .05] ,the cell cycle was arrested in the stage G2/M ;the Transwell experiment results verified that the cell motility and the invasive ability of the experimental group were obviously reinforced compared with the control group[transmenbrane cell numbers in migrant assay :(54 .03 ± 7 .21) vs .(130 .45 ± 14 .13);transmenbrane cell numbers in invasive assay :(17 .75 ± 2 .52) vs .(57 .76 ± 8 .50) respectively] ,the differences had statistical significance(P<0 .01) .Conclusion The overexpression of stathmin promotes the cell proliferation and the invasive ability in SMMC-7721 hepatocellular carcinoma cells .

Purpose To evaluate the correlation between T2-FLAIR hyperintense vessel sign (HVS) and the stenotic degree of internal carotid artery (ICA) and assess the HVS changes after the carotid endarterectomy (CEA). Materials and Methods Fifty-one patients with CEA were retrospectively enrolled. The stenosis of the bilateral ICA were as:≥90%, and<90%. The distribution of HVS locations was classified as three regions:sylvian fissure, sulci of temporo-occipital lobe and other areas. The presence and the location of HVS were counted. The extrension of HVS on T2-FLAIR were graded as:I:the presence of HVS was<1/3 of the MCA territory, II:the presence of HVS was≥1/3 of the MCA territory.χ2-test was performed for correlation between HVS and ICA stenosis. The difference of HVS and stenosis of ICA and their effects on CEA was accessed. Results HVS was significantly higher in the ICA stenosis more than 90%group than in the less than 90% group (χ2=23.584, P<0.001). The frequencies of HVS were 12, 34 and 15 in sylvian fissure, sulci of temporo-occipital lobe and other area, respectively. The proportion of grade II HVS was higher in the ≥ 90% group than in the<90% group (χ2=8.395, P<0.05). After CEA, HVS on 29 affected hemispheres were showed to be disappeared (n=24) or remained (n=5) in the treated side. Conclusion The presence and the grade of HVS were correlated with the stenotic degree of ICA. In the patients with ICA stenosis, HVS was most frequently found in the sulci of temporal lobe and occipital lobe, and seldom found in sylvian fissure. HVS disappeared after CEA indicating that HVS can be considered as a marker for CEA treatment.