Objective:To explore the clinical characteristics and outcomes of pediatric kidney transplantations at a single center and discuss the related clinical issues.Methods:From January 1990 to October 2019, clinical data were analyzed retrospectively for 244 pediatric renal transplants. The youngest recipient was aged 1.8 years and the median age of pediatric recipients was 12.2 years. The major disease was primary or hereditary glomerulonephritis ( n=160, 69.0%), congenital anomalies of kidney and urinary tract (CAKUT), cystic renopathy and other hereditary nephropathies ( n=55, 23.7%). The donor sources included traditional deceased donor ( n=42, 17.2%), living-related donor ( n=19, 7.8%) and organ donation ( n=183, 75.0%). The median age of donors was 2 years (0-51) and the median weight 12.0(2.7-72.0) kg. From January 2013 to October 2019, 170 cases), the major induction immunosuppression regimen was anti-thymocyte globulin (ATG) ( n=110, 64.7%) or basiliximab ( n=58, 34.1%). The maintenance regimen was tacrolimus + mycophenolic acid (MPA) + glucocorticosteroids. Finally the outcomes and the complications were analyzed. Results:The survival rates of 244 kidney allograft recipients were 98.1%, 94.5% and 93.4% and the graft survival rates 92.6%, 84.2% and 82.0% at 1/3/5 years respectively. Ten recipients died of accident ( n=2, 20.0%), pneumonia after transplantation ( n=2, 20.0%) and intracranial hemorrhage ( n=2, 20.0%). Thirty-three recipients lost their allografts mainly due to intravascular thrombosis in graft ( n=5, 14.3%), acute rejection ( n=5, 14.3%) and death ( n=9, 25.7%). Besides, among 109 deceased donor allograft recipients, the postoperative outcomes were delayed graft function recovery (DGF) ( n=27, 24.8%), arterial thrombosis ( n=6, 5.5%), venous thrombosis ( n=1, 0.9%), graft perirenal hematoma ( n=6, 5.5%), raft artery stenosis ( n=10, 9.2%) and graft ureteral fistula ( n=1, 0.9%). The incidence of acute rejection was 17.5% and 23.2% at 1/3 year respectively. The recurrent rate of primary disease was 6.9%, including primary FSGS ( n=3, 42.9%) and IgA nephropathy ( n=2, 28.6%). At 1/3 year post-operation, the incidence of pulmonary infection was 16.9% and 22.4% and the incidence of urinary tract infection 26.9% and 31.7%. Excluding recipients with graft failure, the estimated glomerular filtration rate (eGFR) at 1/2/3 year postoperatively was (80.3±25.2), (81.4±27.8) and (71.8±27.6) ml/(min·1.73 m 2)respectively. Conclusions:The outcomes of pediatric renal transplantations are excellent at our center. Future efforts shall be devoted to optimizing the strategies of donor kidney selection and strengthening preoperative evaluations, perioperative and postoperative managements for improving the long-term outcomes of pediatric renal transplantations.

Objective To explore the clinical outcome of renal transplantation and analyze the risk factors influencing the kidney allograft survival after transplantation.Methods The clinical data of 524 cases of renal transplantation between January 2007 and December 2015 were retrospectively analyzed.Serum creatinine was determined,and glomerular filtration rate(GFR) was estimated.The 1-,2-and 3-year patient and graft survival after transplantation was calculated.Adverse events were recorded.Results The median follow-up time was 17.2 months.The 1-,2-and 3-year graft survival rate after transplantation was 97％,95.8％ and 95.3％,respectively.The 1-,2-and 3-year patient survival rate after transplantation was 97.8％,97％ and 97％,respectively.The eGFR was (67.6 ± 24.1),(68.9±24.2) and (72.7 ± 26.2) ml·min-1 ·1.73 m-2 at 1st,2nd and 3rd year after transplantation.The incidence of delayed graft function(DGF) was 20.6％ (108/524).Multivariate analysis revealed donor type (P =0.005) and the terminal creatinine (P＜0.001) were the independent risk factors of DGF.Elder recipients (P =0.004),recipients with diabetes(P =0.031),preoperative positivity of panel reactive antibody(PRA) (P =0.023),and donor with hypertension (P =0.046) were risk factors influencing the kidney allograft survival.Conclusion Kidney transplantation showed good outcomes at 3rd year after transplantation.The recipient age,recipient's history of diabetes,preoperative PRA and donor's history of hypertension are independent risk factors for renal graft survival.

Objective To analyze the results of inspection certification on malaria elimination in Baise City,and summarize the experiences of malaria elimination at a prefecture level. Methods According to Evaluation Schemes of Malaria Elimination (2014 edition)and Municipal Evaluation Schemes of Malaria Elimination in Guangxi(2016 edition),the malaria elimination work in Baise City was evaluated. In addition,2 counties(cities,districts)in the administrative region of Baise City were ran-domly selected for review assessment. Then the assessment and certification results were analyzed. Results The score of evalua-tion on malaria elimination in Baise City was 95.80,and the scores of review in Tiandong County and Jingxi City were 94.70 and 90.60,respectively. According to the weight of the three scores,namely 0.4,0.3,0.3,the final score of malaria elimination in Baise City was 93.91,which reached the national standards of malaria elimination score(more than 85). Conclusions Baise City has passed the inspection certification of malaria elimination by the authority of Guangxi Zhuang Autonomous Region. How-ever,the malaria monitoring post-elimination still should continue to consolidate the elimination achievements.

Objective To understand the schistosomiasis epidemic and control history in Jingxi City,so as to provide the ev-idence for improving the future work. Methods The data of schistosomiasis prevention and control work were collected and ana-lyzed comprehensively in Jingxi City from 1956-2015. Results From 1956,the schistosomiasis prevention and control work car-ried out,and in 1985,Jingxi City reached the standard of schistosomiasis transmission interrupted and no local schistosome in-fected residents and livestock were found for 36 years. In May 2016,the city reached the national standard of Schistosomiasis Elimination Assessment Review. The cumulative number of schistosomiasis detection of residents was 348801 person-times, and 10434 schistosomiasis patients were found. The cumulative number of schistosomiasis detection of cattle was 20674 head-times,and 590 schistosome infected cattle were found. The cumulative schistosomiasis treatment number of residents was 18739 per-son-times,and 512 cattle were treated. The cumulative detection area with Oncomelania hupensis was 65213.25 hm2 ,and 353.80 hm2 area with O. hupensis snails was found. Conclusions Jingxi City has reached the standard of schistosomiasis elimi-nation,but there is still recurrence of O. hupensis snails,and the imported infection source exists. Therefore,we should strength-en the monitoring of floating population.

Objective To study the protective earth requirement for touched metal parts of medical electrical equipment to improve the manufacturer's understanding on national standards.Methods The isolation methods for the touched metal parts in national standards were studied,and the principle of protective earth combined with insulation separating was analyzed.The characteristics of the second isolation method was discussed,and the respiratory system structure and electroshock protection of the anaesthetic machine were taken as examples.Results The touched metal parts with no measures for grounding,double isolation or reinforced insulation was determined by structure detection to meet the requirements of national standards in case basic insulation ceased to be effective and the parts were uncharged.Conclusion The necessities to girt the touched metal parts with measures for grounding,double isolation or reinforced insulation should depend on the understanding on national standards and electrical construction of the equipment under test by structure detection.

Objective To analyze the necessity of anti-human leukocyte antigen (HLA)antibody monitoring and graft biopsy on early diagnosis of antibody-mediated rejection (AMR). Methods Fifty-one recipients with de novo donor specific antibody (dnDSA)were screened and chosen. Donor specific antibody (DSA)and its ability to bind with C1 q were evaluated. Pathological biopsy of the kidney graft was performed. The recipients diagnosed with AMR were divided into the unstable and stable kidney function groups. Type of DSA,binding ability of the complement and Banff score were statistically compared between two groups. Kaplan-Meier survival analysis of the kidney graft in the recipients from non-rejection, unstable and stable kidney function groups was performed. Results Type of HLA antibody,mean fluorescent intensity (MFI)of DSA,C1 q binding ability and C4d deposition in peritubular capillary did not significantly differ between the unstable and stable groups (all P>0. 05 ). Histomorphologically,the Banff score of microvasculitis,endarteritis,renal tubule-interstitial nephritis,transplantation glomerulopathy and renal tubular atrophy-stroma fibrosis did not significantly differ between two groups (all P>0. 05 ). In the unstable group,the accumulated survival rate of the kidney graft was significantly lower compared with that in the stable group,which was significantly lower than that of their counterparts who were ineligible for pathological diagnosis (P=0. 002). Conclusions It is necessary to perform regular anti-HLA antibody monitoring and pathological puncture examination after renal transplantation,which contributes to early detection and diagnosis of AMR.

Objective To analyze the assessment results and summary the work experience of malaria elimination in Baise City. Methods According to The malaria elimination evaluation schemes of Guangxi(2014 edition),the examination and evaluation of malaria elimination were carried out and all the results were analyzed in 12 counties(county?level city or district) of Baise City from 2014 to 2015. Results Since 2009,there were no local malaria cases and imported secondary cases in Baise City for the 6 consecutive years,and the detailed data were collected and the self?assessment reports of malaria elimination were written in all the counties. There was no omission or delay of malaria case reports in the 12 counties. The highest score of the ex?amination and evaluation was 96.58 points,the lowest was 90.76 points,and the average was 93.77 points. The biggest impact on the evaluation scores was“on?site examination”. Conclusion All the 12 counties(county?level city or district)of Baise City have passed the municipal examination and evaluation of malaria elimination,and the key of next work is malaria monitoring, timely finding and treating the imported malaria patients,and to guarantee no imported secondary cases.

Objective To explore the law and distribution characteristics of malaria prevalence in Pingguo County,Guangxi Zhuang Autonomous Region,so as to provide the evidence for formulating the targeted control strategy and measures after malar?ia elimination. Methods The data of malaria epidemic situation in Pingguo County from 1951 to 2014 were collected and ana?lyzed with the retrospective epidemiological method. Results From 1951 to 2014,there were 71 365 malaria cases reported in the county. The malaria incidence dropped from 429.43/10 000 in 1960 to 0 in 1993. Since 2002,there was no local endogenous infection case reported. In 1993,this county achieved the standard of malaria elimination basically,and in 2014,passed the ex?amination and evaluation of malaria elimination. Conclusions In Pingguo County,the comprehensive malarial control strategy is effective in different stages. In the future,the monitoring of mobile population and dealing with imported malaria cases timely is the key of consolidation of malaria control achievements.

Objective To study the influence of donor GFR on the early renal function in recipients undergoing living donor transplantation.Methods A total of 172 living donor transplant recipients in our kidney transplantation center from 2006 to 2011 were enrolled into this study.Among them,166 were genetically related (96.5％),while 6 were genetically unrelated (spouses in 5 and other in 1).The predonation GFR was measured by isotope clearance (99mTC-DTPA with few exceptions).The range of donor GFR was 62 to 148 ml/min.The recipients were classified into two groups according to donor graft GFR level (GFR≤45 ml/min,n=76; GFR＞45 ml/min,n =96).The predonation dialysis,cold and warm ischemia time,antibody induction,immunosuppressive regimens and HLA mismatch were not significantly different between two groups.Results There were no significant differences in the incidence of postoperative acute rejection and delay graft function (DGF).The postoperative Scr of GFR＞45 ml/min group in 1 week,1 month,3 months and 1 year was lower compared with the GFR ≤45 ml/min group,and only the difference of Scr in 1 week was significantly different (P＜0.05).A repeated-measure ANOVA revealed no significant differences were found in Scr variation of two groups during the first year after transplantation.Conclusions Predonation GFR of the donor has effect on the Scr of postoperative Ⅰ week of recipients,not on the Scr within a year.Recipients with graft GFR＞45 ml/min have lower Scr levels.

Objective To analyze the characteristics of tuberculosis (TB) in renal-transplant recipients from our hospital, and summarize the corresponding experiences in diagnosis and management.Methods A retrospective study was performed on 61 documented post-transplant TB cases out of the 2842 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University between Jan.1991 and Dec.2010.Results TB in the post-renal-transplant population in our hospital displayed the following characteristics:(1) High incidence (2.1％ ).54.1％ recipients were diagnosed within the first year post-transplant; (2) Lung was the most common site (77.0 ％).There was high prevalence (60.7 ％) of extra-pulmonary TB (lymphatic TB,23.0 ％; pleuritis,13.1 ％; graft,11.5％); (3) Fever (83.6 ％),cough (55.7 ％),sputum (41.0 ％) were the most common clinical manifestations.There were also emaciation (3.3 ％) and enlargement of lymph nodes (18.0 ％); (4) Chest X-ray and CT were of great value during TB diagnosis while purified protein derivative of tuberculin (PPD) skin test had little diagnostic value with a negative result in 56 cases (91.8 ％) ; (5) Liver function damage ( 16.4 ％),kidney function injury (39.3 ％) and peripheral nerve toxicity (3.3 ％) were the main adverse reactions of anti-tuberculosis chemotherapy,also the major cause of anti-TB failure; (6) Pre-transplant TB (17 cases) increased the probability of TB recurrence (4 cases,23.5 ％) post-transplantation; (7) The post-transplant TB patients were accompanied with cellular immune deficiency,resulting in overlapping infection of bacteria,viruses and fungi (19.7 ％); (8) 1- and 3-year patient/graft survival rate of patients with post-transplant TB was 85.2 ％/78.7 ％ and 85.2 ％/75.4 ％ respectively. The accumulative mortality rate reached to 14.8％,while overlapping infection was the major cause of death (66.7 ％).Conclusion Chinese renal transplant recipients still face a high risk of TB because of their immunecompromised state and epidemiological prevalence of the disease. For the high mortality rate and associated serious complications,rapid diagnosis and effective anti-TB chemotherapy are of great value for TB population.