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Objective:To explore the long-term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys.Methods:A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results:In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO 2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K + concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero-point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions:NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre-treat organ in vitro.
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Objective:To conduct a retrospective analysis of efficacy and safety of different conversion schemes of tacrolimus to slow-release dosage forms for recipients in stable phase after renal transplantation to provide rationales for the conversion strategy of tacrolimus.Methods:From January 2020 to June 2020, clinical data were reviewed for 101 kidney transplant recipients converting from common tacrolimus dosage form to tacrolimus sustained-release dosage form during postoperative stable period.There were 62 males and 49 females with an age range of 19 to 69 years.They were divided into two groups according to iso-dose and incremental-dose switching schemes.The common dosage form of tacrolimus was converted into a sustained-release dosage form with different conversion doses, They were divided into two groups of 1∶1 conversion( n=55)and >1∶1 conversion( n=46). The clinical parameters of serum creatinine(Scr), blood urea nitrogen(BUN), alanine aminotransferase(ALT)and aspartate aminotransferase(AST), alkaline phosphatase(ALP), serum albumin(ALB), white blood cell count(WBC), urinary white blood cell(UWBC), hemoglobin(Hb)and fasting blood glucose(Glu)were compared between two groups after conversion. Results:Regarding numerical change trend after switching to tacrolimus sustained-release dosage form, drug dose/variation trend was smaller and blood drug concentration more stabilized.In two subgroups converted by 1∶1 and 1>1 initial dose, change trend of dose/blood concentration in 1∶1 conversion group appeared to be more stable.However, no inter-group difference existed in long-term parameters.Scr was lower at 1 week and 3 months after switching to extended-release dosage form( P<0.05)and BUN was lower at 2 weeks( P<0.05). In addition, at 5 months after conversion, ALT and AST significantly improved as compared with common dosage form( P<0.05). Significant differences existed in urinary WBC(UWBC)at 2/3 weeks( P<0.05). After switching for 2 weeks, hemoglobin significantly improved compared with common dosage form( P<0.05). No significant differences existed in ALP, ALB or Glu at other timepoints and pre-conversion( P>0.05). In 1∶1 switch group, renal function tended to improve.At 2 weeks, BUN was lower than pre-conversion; at 1/3 weeks, Scr was lower than pre-conversion( P<0.05). In addition, there was also a trend of improvement in liver function in 1∶1 conversion group.At 1 week and 5 months, ALT was lower than pre-conversion( P<0.05). However, no significant differences existed in AST, ALB, ALP, Glu, UWBC and serum WBC count at each timepoint between two different dose conversion groups( P>0.05). After conversion, intra-individual variability of tacrolimus trough concentration significantly improved( P<0.05). Conclusions:With the same safety and efficacy as common dosage form, sustained-release dosage form of tacrolimus may improve drug variability of individuals.When converting common dosage form into sustained-release dosage form, individual differences should be considered.While monitoring trough concentrations, proper doses should be adjusted on the basis of various clinical parameters.
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The clinical laboratory department practice in hospital is very important in the teaching process of medical laboratory science and medical laboratory technology science .It is the transition link of guiding the students to go to the clinical job .This paper analyzes the problems and challenges in the process of clinical teaching and management of the trainees majored in medical laboratory science and medical laboratory technology science .Then summarizes the countermeasures to effectively cultivate these trainees , including setting up a teaching group , doing the overall quality control for the process of practice teaching using ISO15189 quality control methods for reference , establishing the evaluation mechanism for both trainees and tutors , founding virtual laboratory to improve the teaching effect of morphology , strengthening the consciousness of quality control , expanding the professional vision of interns and strengthening the cultivation of the scientific research ability of interns .
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Objective:To investigate the expression of HIF-1α in serum of rats with contrast induced nephropathy and its effect on renal tubular injury.Methods:45 SD rats were randomLy divided into three groups (n=15).The rats in the blank control group (group A)were treated with 12 h (Sodium Chloride Injection) for three 0.5 mL after fasting water for a period of about 15 minutes.Contrast nephropathy group (B group) rats after fasting 12 h,in the tail vein with 10 mg/kg injection ofindomethacin,15 minutes after the injection of 10 mg/kg nitro-L-arginine methyl ester (L-NAME),15 minutes after the injection ofiobitridol (3 G I/kg).Atorvastatin group (C group) rats in the first 3 days of the experiment started feeding atorvastatin calcium tablets,continuous feeding for 3 days,at a dose of 80 mg/kg/d,and fasting 12 h,making contrast nephropathy model,with the steps of contrast nephropathy group.The changes of renal function indexes (BUN,Cr),HIF-1α expression and renal tubular injury in three groups were observed and compared.Results:The level of BUN in rats with contrast induced nephropathy was lower than that in atorvastatin calcium group and blank control group,but the level of Scr was higher than that of atorvastatin calcium group and blank control group,the difference was statistically significant (P＜0.05).The level of BUN in atorvastatin calcium group was lower than that in blank control group,but Scr level was higher than that in blank control group,the difference was statistically significant (P＜0.05).Compared with the blank control group,the renal tubular injury in the rats with contrast induced nephropathy group was higher than that in atorvastatin calcium group and blank control group,the difference was statistically significant (P＜0.05).Compared with the control group,the expression of HIF-1 was significantly higher in rats with contrast induced nephropathy than that in atorvastatin calcium group and blank control group.The expression of HIF-1 was significantly higher than that in the control group (P＜0.05).Conclusions:It is suggested that the statins could prevent the contrast-induced nephropathy.However,the ending mechanism of statins should be further studied in the clinical practices.
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Objective To study the features of esophageal motility in the cases with myasthenia gravis(MG).Methods 15 healthy controls and 45 patients with MG were tested by using a low-compliance four-lumen hydraulic infusion system,respectively.Focused on the following parameters:PP,UESP,UEP,MEP and MERP.Results There were significant differences of the parameters in between MG cases and healthy controls PP (73.24 ± 31.40) mmHg (1 mmHg =0.133 kPa) vs.(103.78±29.47) mmHg,P=0.002;UESP(41.75 ±21.04) mmHg vs.(60.59 ±17.97) mmHg,P=0.003;UEP (56.63 ±30.26) mmHg vs.(78.98 ±30.14) mmHg,P =0.016;MEP(53.96 ±23.25) mmHg vs.(75.11 ±23.75) mmHg(P =0.004).However,MERP of MG cases or healthy controls seemed to be similar[(-7.76 ± 5.94) mmHg vs.(-7.58 ± 5.76) mmHg,P =0.91).Additionally,the above-mentioned parameters in the cases with generalized myasthenia gravis or dysphagia were significantly different compared with other subtypes or healthy controls (P ＜ 0.01).However,there were no significant differences of the parameters in between ocular MG and healthy controls,or in between MG with and without thymoma.Conclusion The upper and middle part of esophageal motility dysfunction is very common in MG cases,especially in those with dysphagia or generalized MG,characterizing by the declined pressure.Manometry in MG cases can help us classify the subtypes of MG and verify their esophageal motility functions.
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Objective To investigate the clinical effects of gastric bypass( GBP) on type 2 diabetes mel-litus(type 2 diabetes mellitus, T2DM)patients with different body mass index(BMI).Methods T2DM patients undergoing GBP from Sep.2012 to Jul.2013 were divided into 2 groups:obese group( BMI≥28 kg/m2 , 16 ca-ses)and overweight group(BMI0.05).Blood sugar in the obese group decreased with different degrees at 3 and 6 months after surgery.The effective rate was 92%for the obese group and 78%for the overweight group.The overall effective rate was 90%.Conclusion GBP has significant therapeutic value for T2DM patients with different BMI, especially for patients in obese group, which is worth of clinical promotion.
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Objective:To observe features of ambulatory blood pressure in aged patients With hypertension complicated coro-nary heart disease (CHD)and explore the relationship betWeen abnormal ambulatory blood pressure and coronary athero-sclerosis.Methods:According to coronary angiographic results,a total of 220 aged patients With hypertension (>60 years) Were divided into hypertension+ CHD group (n=124)and single hypertension group (n=96).Both groups received 24h ambulatory blood pressure monitoring (ABPM),24h blood pressure (BP),BP variability,pulse pressure and circadian rhythm of blood pressure Were recorded.Results:Compared With single hypertension group,there Were significant increase in 24h,daytime,nighttime mean systolic blood pressure (SBP),SBP variability [dSSD (14.01±4.26)vs. (17.54± 5.51),nSSD (15.05±4.01)vs. (19.32±3.71)],pulse pressure [dPP (56.66±7.43)mmHg vs. (66.32±13.62) mmHg,nPP (55.71±6.62)mmHg vs. (63.86±7.52)mmHg] (P<0.05 all)and percentage of non-dipper rhythm (60.32% vs.82.45%)in hypertension+CHD group,P<0.01.Conclusion:There are significant increase in systolic blood pressure,SBP variability and pulse pressure,percentages of abnormal circadian rhythm in aged patients With hyper-tension complicated coronary heart disease, these abnormality may be related to occurrence and development of coronary atherosclerosis in aged patients With hypertension.
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Objective To investigate the occurrence of healthcare-associated infection(HAI)and catheter-related infection in a general intensive care unit(GICU),so as to strengthen the management.Methods Targeted monitor method was adopted,monitor scheme was established ,personal monitor contents and forms were designed,hospi-talized GICU patients were investigated prospectively between May 2012 and May 2013,and surveyed data were an-alyzed.Results A total of 868 patients were investigated,65 times (7.49%)of HAI occurred;infection rate per day was 21.49‰,adjust infection rate per day was 7.26‰.Infection rate of ventilator-associated pneumonia ,catheter-associated urinary tract infection ,and central venous catheter-related bloodstream infection per day was 23.91‰,3.46‰,and 6.12‰,respectively;the main infection site was respiratory tract (67.69%).Sixty-five isolates of pathogens were detec-ted,81.54%(n=53)of pathogens were gram-negative bacilli,and with multidrug resistance.Conclusion HAI rate is high in GICU ,the use of various types of catheters is an important factor for HAI in GICU patients.Targeted mo-nitoring on ICU is a scientific and effective method ,it can timely reflect the weak links of infection control practice and promote HAI control .
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@#ObjectiveTo investigate the optimun approach to induce the atherosclerotic rat model.MethodsThree methods were used to induce atherosclerotic model, including: simple high fat diet feeding, high fat diet feeding with gastric perfusion of Vitamin D3, and gastric perfusion of Vitamin D3 with common rat food (splashed oil on the normal rat food with yolks and peanuts). Histopathology change of the atherosclerotic plaques in aorta was observed by normal and histopathologic sections and Hematoxylin staining.ResultsThe endarterium of aorta of the rats with simple high fat diet was smooth without atherosclerotic plaques after 2 months. 2 rats with high fat diet feeding and gastric perfusion of Vitamin D3 had formed miliary atherosclerotic plaques. In the rats with vitamin D3 and common rat food, the ring-shape calcified atherosclerotic plaques were found in the all endarterium of aorta.ConclusionGastric perfusion of Vitamin D3 once a week (3 times) combined with common rat diet could induce the atherosclerotic model successfully and decrease the mortality rate.
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Objective To observe the changes of plasma neuropeptide Y (NPY) and neurotensin (NT) levels in patients with heart failure and investigate their clinical significance. Methods The levels of plasma NPY, NT of 76 patients with heart failure and 28 normal controls were determined by radioimmunoassay (RIA). The color echocardiogram was used to evaluate the cardiac structure, function and left ventricular ejection fraction (LVEF). Results The level of plasma NPY in patients with heart failure [(159.7 ± 56.3) ng/L] was higher than that in normal controls [(120.8 ± 51.9) ng/L] (P < 0.05), the level of plasma NT [(69.5 ± 29.6) ng/L] was significantly lower than that in normal controls [(99.1 ± 19.3) ng/L] (P < 0.01). Following the severity of heart failure, the level of plasma NPY increased, and the level of plasma NT decreased. The level of LVEF had negative correlative relationship with the level of plasma NPY (γ = -0.31, P < 0.05) and positive correlative relationship with the level of plasma NT (γ = 0.28, P < 0.05). The level of plasma NPY and NT in patients with heart failure had negative correlative relationship (γ = -0.26, P < 0.05). Conclusions The levels of plasma NPY, NT in patients with heart failure are unbalanced. This unbalance may participate in the damage of cardiac function.
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Objective:To discuss the rule of the prescriptions of professor JIANG Wen-zhao in treating the spleen and stomach ailment. Methods:Use the frequency analysis to analyze the 98 pieces of prescriptions of professor JIANG Wen-zhao in treating the spleen and stomach ailment. Results:To understand medicine state of professor JIANG Wen-zhao in treating the spleen and stomach ailment preliminarily,select the main medicine in treating diseases of the spleen and stomach,and make clear the significance of these medicines to the corresponding diseases. Conclusion:The basic rules of professor JIANG Wen-zhao in treating the spleen and stomach disease are regulating qi,removing dampness and reinforcing asthenia. Qi regulating herbs,diuretics for eliminating dampness,tonifying deficiency herbs,dampness-removing herbs,blood-activating and stasis-removing herbs,heat-clearing herbs are the key herbs.
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Objective:To assess the efficacy of time-resolved fluoroimmuno assay(TRFIA) for quantative determination of?-fetoprotein(AFP) in comparison with radio immuno assay(RIA) and enzme linked immunoabsorbent assay(ELISA). Methods:Thirty serum samples from randomly selected patients were collected to test AFP content with TRFIA,RIA and ELISA respectively.Results:The linear range of AFP was 1 to l 000 ng/ml for TRFIA,5～400ng/ml for RIA and 5～300ng/ml for ELISA.The intraassay coefficients of variation(CV) and interassay CV were 3.3% and 4.7% for TRFIA,5.3% and 8.9% for RIA,and 10.5% and 15.2% for ELISA,respectively.Correlation tests revealed that the results of RIA were more closely correlated with those of TRFIA than with those of ELISA.Conclusion:TRFIA is shown to be a better method for AFP quantitation than RIA and ELISA in terms of precision and linear range.