Objective:To explore the causes, clinical characteristics, diagnoses and outcomes of post-lymphoproliferative disease(PTLD)after renal transplantation.Methods:Retrospective reviews were conducted for a total of 2 844 adult kidney recipients between January 2000 and January 2019. And 13 of them developed PTLD. Their clinical features and outcomes were analyzed. There were 11 males and 2 females with a median age of 55(31~78)years. All were diagnosed as diffuse large B-cell lymphoma at a median time of 86(12~204)months post-transplantation.Results:The locations of PTLD were diverse, including lung, stomach, colon, skin and central nervous system. Biopsy immunohistochemical EBV positivity was detected in 76.9% of cases.After a tapering of immunosuppression intensity, 6 cases were operated. Patients not tolerating R-CHOP regimen (rituximab + CHOP) were switched to R2 regimen(rituximab + nalidomide). The total effective rate was 91.6%, including complete remission(10 cases), partial remission(1 cases), progressive disease (1 case)and death(2 cases).Conclusions:As a rare but serious complication after renal transplantation, PTLD is closely correlated with EBV infection.Reducing the dose of immunosuppressive drugs is a core of comprehensive treatment.Switching to R2 regimen is an effective alternative in the treatment of PTLD after renal transplantation.

Objective:To investigate the clinical curative effect of vitreous cavity injection combined with transconjunctival sutureless vitrectomy on the patients with poliferative diabetic retinopathy.Methods:80 patients with diabetic retinopathy were enrolled in our hospital from January 2014 to January 2016,in which contained 83 sicked eyes,and randomly divided into two groups.Group A (n=40,42 sicked eyes) accepted 25G transconjunctival sutureless vitrectomy,and Group B (n=40,41 sicked eyes) adopted intravitreal injection of conbercept based on patients in Group A.The operative conditions,best-corrected visual acuity (BCV) and retinal thickness were compared between two groups,and the incidence of adverse reactions within postoperative 1 month were recorded and analyzed.Results:The operation time of group B was significantly shorter than that of group A (P＜0.05).The percentage of using electric coagulation,operative bleeding and iatrogenic fracture space in group B were significantly lower than of those group A (P＜0.05).The percentage of neovascularization vanish in group B was significantly higher than that of group A (P＜0.05).The BVCA of patients in group B in postoperative 1 month and 3 month were higher than those of group A (P＜0.05).And the thickness of retinal in group B were significantly thinner than those of Group A (P＜0.05).The incidence of vitreous hemorrhage and hyphema in group B were significantly lower than those of Group A (P＜0.05).Conclusions:Vitreous cavity injection combined with transconjunctival sutureless vitrectomy improved the operative conditions and contributed to the recovery of postoperative visual acuity and retinal in the treatment of patients with poliferative diabetic retinopathy.

Objective:To investigate the effects of xuesaitong on the retinal microcirculation of patients with diabetic mtinopathy (DR).Methods:Ninety-five patients with DR admitted in our hospital were randomly divided into the control group and the observation group.Forty-eight patients in the control group were treated with conventional hypoglycemic agent,and those in the observation group were treated with xuesaitong.The retinal microcirculation indexes including EDV,PSV,RI,Vmax,Vmin,MV,hemorheology indexes including NBL,NBH,DE,Hct,AE,ESR,and clinical efficacy in both groups were observed and compared.Results:After treatment,the clinical efficacy of observation group was 87.8％,which was much higher than that of the control group (61.4％,P＜0.05).The EDV,Vmax,and Vmin of control group were significantly improved than those before treatment (P＜0.05),and EDV and PSV were much higher than those of control group,the RI,Vmax,Vmin,and MV were much lower (P＜0.05).Additionally,the NBL and NBH in control group were much lower compared with those before treatment,while NBL,NBH,DE,Hct,AE,and ESR in control group were improved than those in control group,which were much improved that those of control group (P＜0.05).Conclusion:Xuesaitong combined with conventional hypoglycemic therapy was effective in treating patients with diabetic retinopathy,which could significantly improved the retinal microcirculation and hemorheology.

Objective To investigate changes and the clinical significance of serum 25-Hydroxyvitamin D level in patients of Xinjiang Uygur and Han nationalities with mild cognitive impairment.Methods On the base of early stage of epidemiological survey of Xinjiang Uygur and Han population over 60 years old,adopting multi-stage stratified random cluster sampling method and referencing DSM-Ⅳ,206 cases of MCI patients (study group)were selected and 412 healthy elderly subjects (control) matching for age,nationality and gender were recruited for case-control study.The serum level of 25(OH) D was measured by enzyme-linked immunosorbent assay (ELISA).Results The serum level of 25(OH)D was significantly lower in MCI group of two nationalities (7.89±0.29 μg/L) than in normal control group [(8.65± 0.21) μg/ml,P＜0.05].The serum level of 25(OH)D was (8.41±0.34) μg/L in Han group,and (8.37±0.32)μg/L in Uygur group,with no significant difference (P＞0.05).The 25 (OH)D level was significantly lower in female[(8.23± 0.32) μg/L] than in male [(8.70±0.42) μg/L,P＜0.05].The serum level of 25(OH)D was lower in female MCI group [(7.56±0.34) μg/L] than in female control group [(8.41 ±0.31)μg/L],with significant difference (P＜0.05).While there was no significant difference between male MCI and male control group (P＞0.05).Multivariate Cox regression analysis showed that the risk factors of MCI might include low serum 25 (OH) D levels (OR =1.163,95 ％ CI:0.978-1.447),a decreased physical labor (OR=1.420,95％ CI:1.10-1.860),low education degree (OR =1.504,95％ CI:1.129-2.130),celibacy (OR=1.293,95％CI:0.845-1.440),hypertension (OR=1.954,95％CI:1.342-2.670),diabetes (OR =1.320,95％ CI:1.145-1.710),smoking history (OR =1.350,95％ CI:1.101-2.293),high BMI (OR=1.329,95％CI:1.068-1.781).Conclusions The serum 25(OH)D level is lower in MCI patients in Xinjiang Uygur and Han populations than in normal people,but there is no significant difference.The 25 (OH)D deficiency is associated with increased odds for cognitive impairment in the elderly Xinjiang population,which is more obvious in the female.The occurrence and development of MCI is affected by multiple risk factors.

OBJECTIVE To study the clinical efficacy of voice training on voice recovery in patients with vocal cord polyps during perioperative period.METHODS A total of 72 patients with vocal cord polyp were chosen in this study and they were randomly divided into study group and control group. After operation, the control group received routine treatment, and the study group received voice training on the basis of routine treatment. The results of voice acoustic analysis in the two groups were compared at 8 weeks after operation.RESULTS After 8 weeks, the maximum phonation time(MPT), dysphonia severity index (DSI) and the highest frequency(F0-High) of the study group were significantly higher than that of control group (P<0.05). The fundamental frequency perturbation(Jitter) of the study group was markedly lower than that of the control group(P<0.05). There was no statistical difference in the fundamental frequency(F0), the lowest intensity(I-Low) and amplitude perturbation(Shimmer) between the two group (P>0.05).CONCLUSION Voice training in the early postoperative period of vocal cord polyps was helpful to the recovery of the voice.

OBJECTIVETo assess the association of vitamin D receptor gene (VDR) Apa I, Bsm I genotypes and allele frequencies and mild cognitive impairment (MCI) among elderly ethnic Uygurs from Xinjiang, China.

METHODSThe polymorphisms of the VDR genotypes (Apa I and Bsm I) were analyzed by the SNaPshot method in 124 MCI patients and 124 controls.

RESULTSFactors which can increase the risk for MCI have included the A allele of the Apa I polymorphism [OR=1.62, 95%CI(1.13-2.31)] and the AA genotype [OR=3.49, 95% CI(1.57-7.74)], the T allele of the Bsm I polymorphism [OR=1.94, 95%CI(1.24-3.05)], higher triglyceride and systolic blood pressure levels.

CONCLUSIONPolymorphisms of the VDR gene including the A allele and AA genotype of Apa I, and the T allele of Bsm I are probably associated with MCI among elderly ethnic Uygurs, and so are higher levels of triglyceride and systolic blood pressure.

Aged ; Alleles ; Asian Continental Ancestry Group ; genetics ; Binding Sites ; genetics ; Blood Pressure ; China ; Cognitive Dysfunction ; ethnology ; genetics ; psychology ; Deoxyribonucleases, Type II Site-Specific ; metabolism ; Diagnostic and Statistical Manual of Mental Disorders ; Ethnic Groups ; genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; ethnology ; genetics ; Genotype ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Polymorphism, Single Nucleotide ; Receptors, Calcitriol ; genetics ; Triglycerides ; blood

BACKGROUND:Fol ow-up researches have shown that there is no statistical y difference in safety between kidney donor and healthy person after kidney transplantation, even the donors wil have better life quality. OBJECTIVE:To evaluate the safety of living-related kidney transplantation in living kidney donors. METHODS:Ninety-four cases of kidney donors received 1-10 years fol ow-up through regular clinical fol ow-up, telephone fol ow-up and regular renal patients self-help groups to compare the changes of serum creatinine, hematuria, proteinuria and blood pressure and lipid level in the donors before and after kidney transplantation. RESULTS AND CONCLUSION:The serum creatinine was significantly increased after nephrectomy (P<0.01), but al the donors had normal serum creatinine levels and remained stable. There was no significant difference in serum creatinine level between the latest fol ow-up and discharge (P>0.05). After nephrectomy, three cases (3.2%) suffered from hematuria, two cases (2.1%) had proteinuria, and improved after rest;six cases (6.4%) were subject to hypertension and six cases (6.4%) to hyperlipidemia. Al of the donors were alive. The living donor nephrectomy is feasible and safe. Preoperative assessment and long-term postoperative fol ow-up can guarantee the safety of the donors.

Objective To investigate the correlation between urine levels of IP-10,Mig,OPG and the occurrence of renal allograft rejection.Methods As a retrospective nested case-control study,biopsy confirmed acute rejection reaction by 20 cases was rejection group,and recovery of renal function in kidney transplant after the elect good by 20 cases was control group.morning urine was tested of IP-10,Mig and OPG level of the two groups within 30 d after transplantation.The advantage was taken of the Luminex 2000 test platform,through PlexMark triple kidney injury marker kit to detect the daily urine of recipients.Results The rejection group's urinary IP10 wa (394.7 ± 67.3)ng/L,significantly higher than that in the control group of (10.9 ± 3.8) ng/L (P＜0,05).Urine Mig level of rejection group was (443.0 ± 88.9) ng/L,and the control group was only (15.7 ± 6.99)ng/L.Rejection group was significantly higher than that in the control group (P＜0.05).Urine OPG peak levels,the difference between the two groups was not statistically significant.Rejection group in the rejection period urinary IP-10 and Mig levels were significantly non-exclusion period,the difference was statistically significant (P＜0.01) higher than its level at different times with serum creatinine concentration showed obvious correlation,IP-10 with serum creatinine of correlation coefficients (R2)=0.8673,P＜0.01,Mig and serum creatinine R2 =0.7951,P＜0.01,IP-10 and Mig change time earlier than serum creatinine,to the exclusion of the before and after OPG differences no statistically significant.Conclusion The increasing of IP-1O and Mig content in the urine is associated with acute renal allograft rejection,which is an early reflect of subclinical tubular injury.And its changes as early as elevated serum creatinine,is expected to become independent indicators to predict acute rejection reaction occurs.

Objective To compare the efficacy and safety of conversion from CCB to ARB in the treatment of hypertension and proteinuria in kidney transplant recipients.Methods 127 long-term recipients who used CCB as their anti-hypertensive drug were enrolled.All recipients had stable renal function and no diabetes.Recipients were randomly assigned to experimental group (65 cases) which received ARB (Losartan,50～ 100 mg/day) instead of CCB,or control group (62 cases) which received routine CCB.All recipients were followed up for 2 years.Blood count,urinalysis,liver and kidney chemistry,blood lipid,serum electrolytes,24-h urine protein,blood concentration of CNI drugs and other biochemical indexes were observed.Results During the 2-year follow-up,the blood pressure of the two groups was maintained within normal level.The 24-h urine protein was decreased in the experimental group ( 176.32 ± 54.54 to 155.69 ± 62.25,P＜0.05),but increased slightly in the control group (P＞0.05).Although the blood lipid of the experimental group was not different before and after the follow-up,the high density lipoprotein (HDL) was increased statistically (2.25 ± 0.26 to 2.46 ±0.31,P＜0.05).The blood count,liver and kidney chemistry,serum potassium,blood concentration of CNI drugs in both groups showed no significant differences.Conclusion Both CCB and ARB could be effectively and safely used for the treatment of hypertension and proteinuria in kidney transplant recipients.ARB would be more effective in reducing cardiovascular disease (CVD)rate and decreasing proteinuria.

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.