Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective This study aims to evaluate the initial results of a hybrid procedure for treating descending thoracic aortic disease that involves distal aortic arch.It also intends to report our initial experience in performing this procedure.Methods A total of 45 patients(35 males and 10 females) with descending thoracic aortic disease underwent a hybrid procedure,namely,thoracic endovascular aortic repair(TEVAR) combined with supra-arch branch vessel bypass,in our center from April 2009 to August 2014.Right axillary artery to left axillary artery bypass(n =20) or right axillary artery to left common carotid artery and left axillary artery bypass(n =25) were performed.The conditions of all patients were followed up from the 14th month to the 77th month postoperative[mean(38.0 ± 17.1) months].Mortality within 30 days,complications such as endoleak after the hybrid procedure,and stenosis or blockage of the bypass graft during the follow-up period were assessed.Results One case of death and one case of cerebral infarction were reported within 30 days.Two patients underwent open surgery beacuse of endoleak.And a newly formed intimal tear was observed in one patient and the patient underwent a second TEVAR during the follow-up period.Condusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for thoracic aortic pathologies that involve distal aortic arch.However,this procedure is not recommended for type-B aortic dissection,in which a tear is located in the greater curvature or near the left subclavian artery,because of the high possibility of endoleak occurrence.

Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. How-ever, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain un-clear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Meth-ods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease:im-proving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0%vs. 4.2%, respectively;P<0.001), including acute renal failure (21.4%vs. 0, respectively;P<0.001), and they increased with severity of AKI (P<0.001). The maximum levels of body tem-perature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR:1.023;95%CI:1.003–1.044;P=0.0238) and bilateral renal artery involvement (OR:19.076;95%CI:1.914–190.164;P=0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently oc-curred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.

BACKGROUND:Cuscuta chinensis is a mature seed of Cuscutachinensis Lam., can warm kidney. Previous studies demonstrated that kidney compound composed of Cuscuta chinensis could apparently inhibit bone loss and improve bone density.
OBJECTIVE:To explore the influence of flavonoids from Cuscuta chinensis on bone mineral density of femur, 1,25(OH)2D3 levels of serum and kidney, the expression of smal intestine CaBp-D9K mRNA in model rats with ovariectomized osteoporosis.
METHODS:A total of 72 Sprague-Dawley female rats were equal y and randomly divided into six groups (n=12):sham surgery group, model group, vitamin D3 group and low-, moderate-and high-dose flavonoids groups. The sham surgery group only received sham operation and the other five groups were ovariectomized respectively. One week after ovariectomy, the rats were given flavonoids from low-, moderate-and high-dose Cuscuta chinensis and vitamin D3 (2 mg/kg) by intragastric administration for 3 consecutive months. Blood was obtained from the abdominal aorta. Serum was isolated. The kidney was obtained. Enzyme linked immunosorbent assay was used to determine 1,25(OH)2D3 contents of renal and serum. Rats were sacrificed at the end of experiment. The thighbone was taken out to determine bone mineral density. The second lumbar vertebra was taken out to measure the expression of lumbar vertebra and renal vitamin D receptor mRNA using real-time fluorescent reverse transcription-polymerase chain reaction. The smal intestine was taken out to measure the expression of smal intestine CaBp-D9K mRNA using real-time fluorescent reverse transcription-polymerase chain reaction.
RESULTS AND CONCLUSION:Compared with the sham operation group, bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney and the expression of lumbar vertebra vitamin D receptor mRNA significantly decreased in model group, and the expression of smal intestine CaBp-D9K mRNA significantly decreased in model group. Compared with the model group, bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney, and the expression of the second lumbar vertebra vitamin D receptor mRNA, and the expression of smal intestine CaBp-D9K mRNA were increased in moderate-and high-dose flavonoids groups and vitamin D3 group. Results indicated that flavonoids from Cuscuta chinensis could significantly raise bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney and the expression of lumbar vertebra vitamin D receptor mRNA and the expression of smal intestine CaBp-D9K mRNA, accelerate intestinal calcium absorption and osteoblast activity, and reinforce quality of the bone.

BACKGROUND:There are various methods for the treatment of osteonecrosis of femoral head, but there is no satisfactory method to promote the repair of osteonecrosis of femoral head. In recent years, bone marrow
mesenchymal stem cel transplantation for the treatment of osteonecrosis of femoral head has achieved certain effect.
OBJECTIVE:To review the application progress and problems of bone marrow mesenchymal stem cel transplantation for the treatment of osteonecrosis of femoral head.
METHODS:A computer-based online search was performed in PubMed database, Wanfang database and CNKI database for the related articles from 1999 to 2012. The articles on the isolation, culture, differentiation, labeling and in vivo tracing of bone marrow mesenchymal stem cel s were selected, as wel as the basic and clinical
researches on bone marrow mesenchymal stem cel transplantation for the treatment of osteonecrosis of femoral head. A total of 39 articles were included for review.
RESUTLS AND CONCLUSION:At present, the method for the isolation of bone marrow mesenchymal stem cel s includes adherence screening method, density gradient centrifugation, flow cytometry separation and magnetic activated cel sorting method;the commonly used method for cel labeling and tracing includes isotope tracing method, antigen labeling method, antigen labeling, fluorescent labeling and MRI contrast enhancer labeling
method. The method for the treatment of osteonecrosis of femoral head with bone marrow mesenchymal stem cel s includes pith dril ing decompression combined with bone marrow mesenchymal stem cel injection and
transplantation, intervention plus bone marrow mesenchymal stem cel transplantation, gene transfection combined with bone marrow mesenchymal stem cel transplantation and tissue engineering technology of bone marrow mesenchymal stem cel s. Although, the research on the bone marrow mesenchymal stem cel transplantation for the treatment of
osteonecrosis of femoral head has achieved great progress, there are stil problems needed to be further solved.

BACKGROUND:To construct a normal animal model of femoral head necrosis contributes to the research of the pathogenesis of femoral head necrosis, which can provide theoretical basis for the prevention and treatment of femoral head necrosis.
OBJECTIVE:To research the experimental effect of lipopolysaccharide combined with dexamethasone injection in the induction of rabbit femoral head necrosis.
METHODS:Thirty-six New Zealand white rabbits were randomly divided into model group (n=21) and control group (n=15). The rabbits in the model group were injected with 10μg/kg lipopolysaccharide daily and continuous for 2 days, and then injected with 25 mg/kg dexamethasone daily for 3 days continuously. The rabbits in the control group were injected with the normal saline at the same volume.
RESULTS AND CONCLUSION:After 4 weeks, the X-ray film of the rabbit in the model group showed the joint gaps were widened, the density was increased, the articular subchondral bone mineral density was increased, the femoral head was flat, trabecular bone was fuzzy, the boundaries between subchondral bone and cancel ous bone was unclear, and the patchy high-density areas were observed in the femoral head with shortened femoral neck. The bone mineral density of partial femoral head was measured with dual-energy X-ray absorptiometry, and found that the bone mineral density of femoral head and the bone mineral content of the model group were significantly lower than those of the control group (P<0.05). Histological section observation showed that the bone cel lacuna was empty and shal ow, fat cel s were increased and vascular thrombosis was observed, meanwhile, the osteonecrosis rate and lacunae rate of the survival animals were significantly higher than those in the control group. Dexamethasone combined with lipopolysaccharide can effectively construct the model of steroid-induced avascular necrosis of the femoral head.

BACKGROUND:Animal death is a main influential factor for experimental results in establishment of animal models of steroid-induced necrosis of femoral head.
OBJECTIVE:To observe models of femoral head necrosis established using lipopolysaccharide and dexamethasone so as to elevate success rate of model induction.
METHODS:A total of 48 New Zealand white rabbits were equal y and randomly divided into model group, gentamicin group, gentamicin+lansoprazole group and control group. The first three groups were injected with lipopolysaccharide for 2 consecutive days via the ear vein, and then they were injected with dexamethasone via intramuscular injection in the buttocks for 3 consecutive days to establish models of femoral head necrosis. The rabbits of gentamicin group, gentamicin+lansoprazole group were intragastrical y administered gentamicin for 7 consecutive days after success model induction. Simultaneously, gentamicin+lansoprazole group received intramuscular injection with lansoprazole. Rabbits in the control group were only injected with saline.
RESULTS AND CONCLUSION:Models were successful y established in the model, gentamicin, gentamicin+lansoprazole groups. Their conditions were best in the gentamicin+lansoprazole group. Mortalities in above-mentioned groups were 33.3%, 25%and 8.3%, respectively. Significant differences in the number of dead rabbits were detected in the model, gentamicin, gentamicin+lansoprazole and control groups (P<0.05). Results indicated that the combined use of gentamicin and lansoprazole can elevate survival rate of experimental animals during the establishment of rabbit models of steroid-induced necrosis of femoral head.

Objective To explore the effect of total flavonoids of Epimedium sagittatum (TFE) on the mRNA expressions of the estrogen receptor alpha (ERα) and estrogen receptor beta(ERβ) in hippocampus and hypothalamus in ovariectomized (OVX) Sprague-Dawley(SD) rats, and the mechanism of TFE against postmenopausal osteoporosis. Methods Forty-eight female SD rats,aged 10-11 months old, were randomly divided into 4 groups: a sham group, an ovariectomy group (rats were bilaterally ovariectomized), a TFE group, and a 17β-estradiol group (rats were fed with TFE and 17β-estradiol for 4 months, respectively). The RT-PCR was performed to determine the mRNA expression of ERα and ERβ in hypothalamus and hippocampus. Results Serum estradiol level, bone mineral density (BMD) of vertebra,wet weight of uterus, and the mRNA expressions of ERα and ERβ in hypothalamus and hippocampus were markedly decreased in OVX rats, all of which were reversed by 17β-estradiol treatment except the mRNA expression of ERβ. Similar results were achieved by TFE treatment except the wet weight of uterus. Conclusion TFE can improve BMD of vertebra in the OVX rats without side effects on the uterus. The mechanism may be related to increasing the mRNA expressions of ERα and ERβ in hypothalamus and hippocampus.

OBJECTIVETo study the relationship between tissue quantitative distribution and pharmacokinetics of 3H-achyranthes bidentata ecdysterone and the channel-tropism of herbal drugs in mice.

METHOD3H-achyranthes bidentata ecdysterone was used as a tracer agent and injected into mice by the caudal vein. In 36 hours, the contents of the tracer agent of samples involving 9 different tracing phases and organ or tissue were determined in order to observe the dynamic quantitative distribution and excretion and pharmacokinetics of 3H-achyranthes bidentata ecdysterone and to understand the channel-tropism of herbal drugs achyranthes bidentata.

RESULT3H-achyranthes bidentata ecdysterone of same organs in different tracing phases and the contents of 3H-achyranthes bidentata ecdysterone in same tracing phases of different organs were significantly different (P<0.01). 3H-achyranthes bidentata ecdysterone was mainly distributed, in the liver, kidney, adrenal gland, small intestine and lung. The concentration-time profiles of achyranthes bidentata ecdysterone in rats injected into mice by the caudal vein were shown to fit a two-compartment open model with half-lives of (778.65 +/- 12.36) min, the elimination of achyranthes bidentata ecdysterone from plasma was found to be in accord with linear kinetics.

CONCLUSIONThe above mentioned selective distribution of 3H-achyranthes bidentata ecdysterone basically coincides with the meridian affinity and zang fu selection of the traditional Chinese medicine drug Achyranthes bidentata. This study will provide a scientific basis for the channel-tropism of A. bidentata.

Achyranthes ; chemistry ; Animals ; Drugs, Chinese Herbal ; metabolism ; pharmacokinetics ; Ecdysterone ; metabolism ; pharmacokinetics ; Isotope Labeling ; Male ; Meridians ; Mice ; Organ Specificity ; Tissue Distribution ; Tritium ; chemistry

ObjectiveTo explore the experiences of treatment of aortic root aneurysm and mitral valve disease through the incision of aorta.MethodsFrom Mar.2009 to Dec.2010, sixteen patients with aortic root aneurysm and mitral valve disease were operated by transaortic incision.After the leaflets of aortic valve were excised, mitral valve replacement or plasty was performed.There were 13 males and 3 females.The age ranged from 18 to 75 years old with a mean of (40 ± 10) years.The operation procedures included Bentall plus mitral valve replacement in 12 patients, Bentall plus mitral valve plasty in 1,Bentall + total arch replacement + stent elephant trunk + mitral valve plasty in 1, Bentall plus mitral valve plasty and CABG in 1.In 12 patients underwent mitral valve replacement, 11 were using continuous suture and interrupt mattress suture in 1.Four patients underwent mitral valve plasty, the procedure of banding mitral valve leaflets junctions was used.All patients were followed up through telephone and out-patient service.Transthoracic echocardiogram was performed before discharge and 3-, 6-,12-months after operation.Follow-up including cardiac function, valvular and perioperative complications.Results There were 2 re-thoractomy because of bleeding.One patient with pulmonary infection was cured by antibiotics.No death occurred in hospital.Patients were followed-up for 1 to 19 months with a mean of (7 ±5) months.No death occurred during follow-up period.There were no valve-related complications (embolism, bleeding, mitral valve dysfunction).Heart function was improved in all patients and graded as class Ⅰ to Ⅱ (NYHA).Two patients had trace regurgitation after mitral valve plasty when discharged.One patient had mild mitral valve regurgitation was found after mitral valve replacement.There was no further valve exacerbation for above 3 patients during follow-up period.ConclusionTransanrtic mitral valve operation is feasible in patients with aortic root aneurysm and mitral valve disease.