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Based on the teaching concept of constructivism, this study aims to promote independent inquiry-based learning and clinical thinking among students and establish the guiding ideology of "full participation, process control, in-depth discussion, and expansion of thinking". A blending learning model was adopted with offline inquiry-based group learning and in-class defense and comment, as well as online teacher-student interaction and supervision to promote learning. Case-problem-based learning (CPBL) of pathophysiology was carried out among the medical students in the class of 2017, and process management was strengthened to effectively manage the two key links of data retrieval and group discussion. The analysis of 176 teaching evaluations collected at the end of the semester show that in terms of the overall evaluation of CPBL teaching, 162 students (92.05%) had high evaluation on teaching objectives, organization, cases, and personal gains and held a very or relatively favorable attitude. There were more negative feedbacks on "appropriate time allocation"; 21 students (11.93%) held a relatively or very disapproving attitude, and 149 students (84.66%) "felt very tired". In terms of teaching effect evaluation, 150 students (85.23%) strongly or relatively agreed that CPBL teaching may help to understand professional knowledge, stimulate learning enthusiasm and initiative, improve problem solving ability, emphasize clinical practice to cultivate clinical thinking, supervise and promote learning, and enhance team cooperation and teacher-student communication. In terms of the evaluation of teachers, 167 students (94.89%) thought that teachers were rigorous, responsible, and enthusiastic in teaching, attached importance to process management, and did well in effective guidance and thinking inspiration (strongly or relatively agree). The above results suggest that the CPBL teaching reform of pathophysiology based on process management can effectively promote in-depth inquiry-based independent learning and the cultivation of clinical thinking and improve teaching effectiveness, but further improvement is needed for teaching arrangement and time allocation.
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Objective:To evaluate the effectiveness of staged modular theory and practice lectures in laparoscopic training.Methods:In this study, a large group of medical students and a large group of residents were selected, and each of the two groups was divided into an experimental group and a control group respectively. The experimental group received staged modular theory and practice lectures based on the conventional trainings, and the control group only underwent conventional laparoscopic skills training and instruction. Before and after the training, the completion time of 6 basic laparoscopic operations, laparoscopic suture time, suture quality and the number of accidental injuries were recorded and scored in each group according to the assessment criteria. SPSS 26.0 was used for statistical analysis of the assessment data. Independent samples t-test or Mann-Whitney U test was used for inter-group comparison between the two large groups, and paired samples t-test or Wilcoxon sign rank sum test was used for intra-group comparison before and after the training. Results:Compared with the control group, the experimental group of medical students that had undergone staged modular theory and practice lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=6.18, P<0.001) and higher quality of suturing ( t=4.17, P<0.001) and fewer accidental injuries ( Z=-2.03, P=0.043); the experimental group of residents that had undergone staged modular theoretical and practical lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=3.31, P=0.002) and higher quality of suturing ( t=3.68, P=0.001) and fewer accidental injuries ( Z=-2.44, P=0.015). Conclusion:The staged modular theory and practice lectures are able to further improve the quality of basic laparoscopic skills training.
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Objective To provide guidance for pre-hospital emergency treatment by studying the disease spectrum and distribution characteristics of pre-hospital emergency treatment patients in Wuxi area from 2015 to 2020. Methods The medical records of 120 pre-hospital emergency patients in Wuxi area from January 2015 to December 2020 were retrospectively analyzed, and the disease types, gender, age, and seasonal distribution of the pre-hospital emergency patients were statistically analyzed. Results The top five emergency diseases of 16 437 pre-hospital patients were trauma (24.51%), cerebrovascular disease (19.16%), cardiovascular disease (18.33%), digestive system disease (9.70%) and respiratory disease (7.20%). In the distribution of disease types, the proportions of injuries, cerebrovascular diseases, cardiovascular diseases, digestive system diseases, respiratory system diseases, poisoning diseases and urinary system diseases in males were significantly higher than those in females (χ2=4.975, P<0.05). The proportion of male species (9 812/16 437) was higher than that of female species (6 625/16 437). From 2015 to 2020, the age group with high incidence of pre-hospital emergency patients in Wuxi area was distributed in the 50-60 years old (19.30%) and 40-50 years old (16.28%), and the least age group was 0-10 years old (2.60%). The number of pre-hospital emergency patients was 46.60% from 6 to 12 hours per day, and 10.26% from 18 to 24 hours per day. The number of pre-hospital emergency patients was the highest in summer (38.69%), and the lowest in spring (11.87%). Conclusion The pre-hospital emergency diseases in Wuxi area are mainly cardiovascular and cerebrovascular diseases, and the acute and severe diseases show an increasing trend. It is necessary to rationally allocate the pre-hospital emergency resources according to the disease spectrum and the peak months and time periods of different diseases, so as to improve the medical service level in Wuxi.
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Objective To analyze the prediction efficiency of scoring models at home and abroad on delayed graft function (DGF) after renal transplantation in China. Methods The clinical data of 112 donors and 220 recipients undergoing renal transplantation were prospectively analyzed. The DGF predicted by KDRI model, Jeldres model, and model of our center was compared with actual DGF incidence of renal transplant recipients. The prediction efficiency of each model was analyzed. The predictive accuracy was compared by the area under curve (AUC) of receiver operating characteristic (ROC) curve. Results The DGF incidence of 220 renal transplant recipients was 14.1% (31/220). DGF prediction using KDRI model showed that 41 cases were high risk donors, the AUC was 0.57, the sensitivity was 0.37, the specificity was 0.66, and the positive predictive value was 22%. DGF prediction using Jedres model showed that 22 cases were high risk recipients, the AUC was 0.56, the sensitivity was 0.13, the specificity was 0.92 and the positive predictive value was 20%. DGF prediction using the model of our center showed that 25 cases were high risk donors, the AUC was 0.80, the sensitivity was 0.53, the specificity was 0.84, the positive predictive value was 40%. Conclusions Compared with the KDRI and Jedres models, the prediction model of our center has higher AUC and sensitivity with a better prediction efficiency on DGF. Therefore, it is a suitable evaluation system of donors from donation after citizen's death in Chinese.
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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.
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Objective To study long term renal function of Donation after citizen's deceased transplantation.Methods We compared the data of 38 subjects who got Delayed Graft Function(DGF) with 80 Immediate Graft Function (IGF) subjects underwent DCD transplantation in our hospital before June 2016.Evaluated the renal function by detecting the serum creatinine (sCr),the estimating glomerular filtration rate (eGFR) calculated with MDRD formula and urine protein at the 1,2,3 year post transplantation.Results Analyzed the serum eGFR of two groups,there was no significant differences at 1 and 2 year post transplantation,sCr of two groups showed no significant differences at 3 year (P =0.053)post transplantation,eGFR of two groups showed significant differences at 3 year (P =0.042)post transplantation and positive incidence of urine protein showed significant differences at 2 year (P =0.028)and 3 year (P =0.037)post transplantation.Conclusion DGFoccuring after DCD transplantation had an effect on long term renal function,.mainly on reducing of eGFR and increasing of urine protein positive rate 2 or 3 years after transplant.
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Objective To investigate the influence of quality evaluation of donated kidney after citizen's death on prognosis of renal allograft recipients.Methods A retrospective analysis on 577 cases of deceased organ donation/1084 cases of renal transplantation was made in the First Affiliated Hospital of Xi'an Jiaotong University from December 2011 to August 2018.The quality of donor/ donated kidney was evaluated through various aspects,and the prognostic data of renal transplant recipients were summarized and analyzed.Results 1 084 cases of donated kidney transplantation were completed,and the average follow-up time was (14.3 ± 13.5) months.The 1-and 3-year survival rate of transplant recipients was 97.4％ and 92.1％,respectively,and the 1-and 3-year survival rate of transplanted kidney was 94.6％ and 89.2％ respectively.There were significant differences in human/ kidney survival rate and DGF incidence after renal transplantation among those various groups according to the criteria of subdivision of score of points for donor assessment.Conclusion Comprehensive evaluation of donated kidney quality in all aspects has a significant positive effect on improving the effect of transplantation.
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Objective To explore the clinical effect of renal transplant from donation after citizen's death (DCD) donors with acute kidney injury (AKI).Methods This was an observational retrospective study of 622 patients who underwent renal transplantation from 312 DCD donors' kidneys at the First Affiliated Hospital of Xi'an Jiaotong University from December 2011 to December 2016.The transplant patients were divided into AKI group and non-AKI group according to the Acute Kidney Injury Network (AKIN) criteria based on initial and terminal creatinine values.We evaluated and compared transplant outcomes of these two groups.Results There were 131 donors with AKI,and the incidence of AKI was 42.0 ％.AKI group and non-AKI group recipients respectively had DGF in 20.2％ and 7.2％ of cases (P＜0.01),153.6 ± 56.2 and 119.3 ± 40.7 μmol/L of serum creatinine (SCr) levels at 1st month (P＜0.01),and 38.5 ± 14.1 and 57.6 ± 23.4 ml· min-1 (1.73 m2)-1 of eGFR at 1st month (P＜0.01).There was no significant difference in SCr and eGFR between two groups at 1st year after transplantation.Conclusion Most of kidneys from DCD donors with AKI can be considered for transplantation.Renal transplantation of organs from DCD donors with AKI showed greater DGF but good outcomes.
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Objective To investigate the therapeutic effects of modified Xiaoyao Powder combined with abdominal needling for conducting fire back to its source for the treatment of swallowing dysfunction in Parkinson's disease, and to explore a more effective therapy for swallowing dysfunction in Parkinson's disease. Methods Forty-two Parkinson's disease patients suffering from swallowing dysfunction were divided into treatment group and control group, 21 cases in each group. The patients in both groups received routine swallowing function training. In addition to the training, the treatment group was treated with modified Xiaoyao Powder combined with abdominal needling for conducting fire back to its source, and the control group was given conventional western medicine of Domperidone and Levodopa Benserazide Hydrochloride. After treatment for 3 weeks, we compared the dysphagia scores and effective rate of the two groups. Results (1) All of the patients in the treatment group completed the trial, but 2 cases of the control group dropped out. Therefore, a total of 40 cases completed the trial. (2) The dysphagia scores of the two groups were much improved after treatment (P<0.01 compared with those before treatment) , and the improvement of the treatment group was superior to that of the control group (P < 0.05). (3) After treatment for 3 weeks, the total effective rate of the treatment group was 95.24% and that of the control group was 52 . 63%, and the difference was statistically significant between the two groups(P<0.01).(4) Gastrointestinal reaction occurred in 3 cases(one from the treatment group and 2 from the control group) , but there were no other side effects found in both groups. Conclusion Modified Xiaoyao Powder combined with abdominal needling for conducting fire back to its source is more effective for the treatment of swallowing dysfunction in Parkinson's disease than routine western medicine treatment.
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Objective To evaluate short-term clinical efficacy of renal transplantation from the donation of pediatric donors.Methods Clinical data of 1 5 pediatric donors and 28 recipients (including 2 cases of bilateral renal transplantation)undergoing renal transplantation in the Department of Renal Transplantation of the First Affiliated Hospital of Xi'an Jiaotong University from November 201 3 to December 201 5 were retrospectively analyzed. Results Renal transplantation was successfully performed in 28 recipients.The median warm ischemia time of transplant kidney was 1 2.5 min (range:0-1 7.0 min)and 4.3 h (range:1 .5-7.7 h)for the median cold ischemia time.After operation,4 cases developed with delayed graft function (DGF),1 required dialysis,2 died from pulmonary infection,2 underwent renal resection due to renal anastomosis stenosis and renal thrombosis.Postoperative follow-up lasted for 1 -24 months.Twenty-six (93%)recipients survived after renal transplantation and 24 (86%)recipients survived with restored normal renal function.Conclusions Unilateral and bilateral renal transplantation from pediatric donors has relatively favorable short-term clinical efficacy.
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OBJECTIVE:To explore the feasibility of question-and-answer practice teaching in the pharmacy department of our hospital. METHODS:The practice teaching of pharmacy department was taken as a pilot,and the question-and-answer practice teaching was used in emergency and outpatient pharmacies,inpatient pharmacy,PIVAS,drug warehouse,clinical pharmaceutics room,preparation room and drug testing laboratory. The effects of the practice teaching on internships,teachers,pharmacy depart-ments and patients were excavated. RESULTS & CONCLUSIONS:Satisfaction of teachers,pharmacy,patients and clinics for the question-and-answer practice teaching was 100%,and satisfaction of internships was 94.5%. The question-and-answer practice teaching has improved their professional knowledge and competence,resolved difficulty of patients about drug counseling and helped the improvement of overall business level in department.
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OBJECTIVE@#To investigate islet graft survival and function after co-culture and co-transplantation with vascular endothelial cells (ECs) in diabetic rats.@*METHODS@#We isolated ECs, and assessed the viability of isolated islets in a group of standard culture and a group of co-culture with ECs. Then we put the diabetic rats in 4 groups: an islet transplantation group, an islet graft with EC transplantation group, an EC transplantation group, and a PBS control group. Blood glucose and insulin concentrations were measured daily. Cell morphology and cell markers were investigated by immunohistochemical staining and electron microscope.@*RESULTS@#Normal morphology was shown in more than 90% of AO/PI staining positive islets while co-cultured with ECs for 7 days. Insulin release assays showed a significantly higher simulation index co-culture except for the first day (P<0.05). There was a significant difference in concentrations of blood glucose and insulin among the 4 groups after 3 days after the transplantation (P<0.05).@*CONCLUSION@#EC-islet co-culture can improve the function and survival of isolated islets in vitro, and EC-islet co-transplantation can effectively prolong the islet graft survival in diabetic rats.
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Animals , Rats , Blood Glucose , Coculture Techniques , Diabetes Mellitus, Experimental , Endothelial Cells , Cell Biology , Graft Survival , Insulin , Blood , Islets of Langerhans , Cell Biology , Islets of Langerhans TransplantationABSTRACT
<p><b>BACKGROUND</b>People's attitude toward organ donation after cardiac death (DCD) has not come to an agreement in different countries and regions. Influenced by the local culture in China for thousands of years, the general public has different ideas about this issue. The purpose of this study was to investigate the current attitudes trend and characteristics of transplantation with organs donated after cardiac death in northwest China.</p><p><b>METHODS</b>This largest single-center cohort study was performed by an interview or by telephone using a questionnaire. The family members of potential DCD donors were recruited from the First Affiliated Hospital, medical college of Xi'an Jiaotong University located in a metropolitan area of northwest China. The 12-item attitude questionnaire was specifically developed from the literature review with coordinator, physician, and donor's family feedback. The participants were asked to rate the queries on a 5-point Likert intensity scale.</p><p><b>RESULTS</b>The 174 participants included 56 (32.2%) women and 118 (67.8%) men. Most people were aged between 41 and 50 years (n = 63, 36.2%), 31 and 40 years (n = 59, 33.9%), and less than 30 years (n = 36, 20.7%). The top five attitudes of participants were the best person to suggest organ donation to a family was ranked as the DCD coordinator of Red Cross Organization (RCO, n = 160, 92%), donor is a hero (n = 143, 82.2%), honor to be a donor's family member (n = 136, 78.2%), improved relationship with colleagues (n = 124, 71.3%), and with recipient after donation (n = 123, 70.7%). The best person to suggest organ donation to a family was ranked as the coordinator of RCO (n = 160, 92%), doctor unrelated to transplantation (n = 104, 59.8%), social worker (n = 36, 20.7%), and doctor related to transplantation (n = 25, 14.4%). The top two reasons for non-consent to donation were that the family insisted on intact body after patient death and did not want to have surgery again (n = 51, 41.5%), and feared that they would be misunderstood by neighbors, relatives, and friends about donation (n = 28, 22.8%).</p><p><b>CONCLUSIONS</b>This study revealed initial attitudes toward DCD in China. Some data afford insight into the decision-making procedure. The concerns of potential DCD donors and their families may help professionals provide better interventions in the future.</p>
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Adult , Female , Humans , Male , Middle Aged , Attitude , China , Death , Decision Making , Surveys and Questionnaires , Tissue and Organ ProcurementABSTRACT
<p><b>OBJECTIVE</b>To explore the effect of donations after cardiac death (DCD) kidney transplant performed in northwest China and the measures for management of delayed graft function (DGF).</p><p><b>METHODS</b>In the period of 2011-2013, a total of 51 families of DCD donor gave their consent to organ donation by signing the informed consent with the help by a Red Cross Organization (ROC) coordinator, and 102 kidneys were retrieved by organ procurement organization (OPO) teams. Ninety-four operations of renal transplantation were carried out in our hospital. All the patients were followed-up and based on the occurrence of DGF after transplantation, they were divided into DGF group and non-DGF group for comparative studies.</p><p><b>RESULTS</b>The success rate of donation after cardiac death was 29.3%, and the incidence of post-transplantation DGF was 27.7%. The 1-year human/kidney survival rate was 98.9%/95.7%. Within six months after the transplant, the values of eGFR in DGF group were significantly lower and serum creatinine significantly higher than those in non-DGF group (P<0.05), but no significant differences were found between the two groups thereafter (P>0.05). The occurrence of DGF in LifePort mechanical perfusion cohorts was significantly lower than that in the simple cold preservation group (21.5% vs. 41.4%, P<0.05).</p><p><b>CONCLUSION</b>The overall effect of DCD kidney transplant is good despite a high incidence of early DGF, and we recommend the use of low-temperature mechanical perfusion for storage and transportation of DCD donor kidney.</p>
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Adult , Female , Humans , Male , Young Adult , China , Death , Delayed Graft Function , Kidney Transplantation , Tissue and Organ ProcurementABSTRACT
Objective To analyze the risk factors affecting long-term survival of recipients and renal allografts.Methods From January 1979 to December 2001,the clinical data of 1380 renal allograft recipients were retrospectively analyzed.The clinical and complication data of kidney transplantation were reviewed.Thirteen relative factors were analyzed by SAS statistical software.A Kaplan-Meier rank analysis was used to estimate the 10-year allograft survival rate.Proportional hazards regression analysis (with Cox model) was used to assess and rank the relative risk of potential variable.Results (1) As of Dec.31,2001,utility visiting rate was 93.62％,989 recipients survived over 10 years.The complications were as follows:acute rejection (191 cases),infection (112 cases),liver damage (106 cases).The postoperational 10-year survival rate of recipients and renal allografts was 71.67％ and 62.25％ respectively.(2) CAN,acute rejection,DGF,infection,diabetic mellitus,PRA ＞10％ and HLA mismatch＞3 were the independent risk factors resulting in the reduced survival rate of the renal allografts (P＜0.05).Immunosuppressive regimen with MMF could significantly increase long-term survival rate (P＜ 0.01); (3) The cardiocerebral vascular diseases,liver insufficiency,infection,tumor and diabetic mellitus were independent risk factors for long-term survival (P＜0.01).Conclusion The ideal HLA match is the key step in increasing survival rate; Low dosage of calcineurin inhibitor with MMF and Pred is the ideal regimen of immunosuppressive therapy for long-term survival; active prevention and treatment of cardiocerebral vascular diseases/CAN,infection,diabetic mellitus,and tumor are the main points focused during the follow-up period.
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Objective To explore the clinical significance of switch between ciclosporin A (CsA) and tacrolimus (TAC) in the triple immunosuppressive protocol including calcineurin inhibitors (CNI),mycophenolate mofetil (MMF),and prednisone (Pred) after renal transplantation.Methods The data of 148 patients with CNI switch were collected from Jan.2000 to Dec.2010,including 51patients with Tac switching to CsA (group A) and 97 patients with CsA switching to Tac (group B).The clinical indexes were analyzed by paired t-test.Results In group A,the serum creatinine,urea and blood glucose were significantly reduced,and hemoglobin,bilirubin,cholesterol significantly increased as compared with those before switch (P＜0.05).In group B,the serum creatinine and urea began were significantly reduced from 4th and 2nd week respectively after switch (P＜0.05).Platelet counts began significantly dropping from 20th week after switch (P＜0.05).Albumin,globulin and bilirubin were significantly increased from 20th,12th and 36th week respectively after switch (P＜0.05).Blood glucose and cholesterol were significantly decreased from 12th and 3rd week respectively after switch (P＜0.05).The trough concentrations of CNI and MMF AUC kept stable before and after switch.Conclusion The renal function of all patients was improved to varying degrees by CNI switch between CsA and Tac no matter what reason.The switch of immunosuppressive agents has benefits to alleviate adverse reactions.
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Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.
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Objective To evaluate the clinical value of adenosine triphosphate (ATP) determination in CD4+ cells in cytomegalovirus pneumonia after renal transplantation.Methods The ATP level of CD4+ T cells was measured by ImmuKnowTM kit.The ATP levels were determined in 187 renal transplant recipients before and 30,60,90,180 days after operation,and at the time of CMV pneumonia and 4 weeks after treatment of CMV pneumonia.The associations between ATP levels and CMV pneumonia were analyzed.Analysis of variance (ANOVA),Pearson-Spearman and relative risks were used for data analysis.Results 17 cases out of 187 renal transplant recipients were diagnosed as CMV pneumonia (9.1％),and the onset of CMV pneumonia started on the (2.8 ±1.2)month after renal transplantation.ATP concentrations in CD4+ T cells were significantly lower after operation than those before operation (P＜0.01).ATP concentrations reached the lowest on the about postoperative day 90 (P＜0.05),then increased gradually.In 17 recipients with CMV pneumonia,the ATP levels before and 30,90 days after operation,at the time of CMV pneumonia and 4th week after treatment of CMV pneumonia were (376 ±182),(283 ± 146),(196 ± 112),(145 ± 102) and (236 ± 117) μg/L respectively.ATP levels at the time of CMV pneumonia were significantly lower than any other time points (P＜0.05).There was close correlation between ATP levels and CMV pneumonia.Conclusion The determination of ATP in CD4+ cells could reflect the status of cell-mediated immunity in renal transplant recipients,and could evaluate the severity and prognosis of CMV pneumonia and guide the clinical treatment.
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Objective To study the expression of immunoglobulin-like transcripts 3 (ⅡT3) and ILT4 in peripheral blood dendritic cells (DC) of kidney transplantation recipients and to analyze its significance in immunity hyporesponsiveness of transplantation. Methods Twenty kidney allograft recipients who were survived more than five years were recruited to two groups: renal function stable groups, chronic rejection groups, and 10 healthy volunteers served as a control group. The peripheral blood mononuclear cells (PBMC) were stimulated with granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin 4 (IL-4) and immature DC were obtained. The expression of ILT3 and ILT4 was detected by using flow cytometry. The level of HLA-G5 in serum was determined by using enzyme linked immunosorbent assay. Results ILT3 expression in renal function stable group was increased and decreased in chronic rejection groups as compared with control group (P＜0.05),but ILT4 expression had no significant difference among all groups. HLA-G5 in serum was significantly increased in renal function stable group as compared with other groups. Conclusion Expression of ILT3 and HLA-G was increased in the kidney transplantation recipients with stable renal function and long-term survival, suggesting that they may play an important role in inducing and maintaining periphery immune tolerance.
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Objective To investigate the effects of HLA matching on long survival of patients with kidney transplantation. Methods In 2508 cases of renal transplants, based on Ag M standard, in 0 MM-6 MM (7 groups), the effects of HLA matching on the survival rate of 1 year, 5 years and 10 years, and the incidence of renal acute rejection (AR) in renal allografts were analyzed. Results Only 7 cases had 0-missmatches, and most cases had 2 or 3 missmatches. In the group of zero antigen mismatches, the incidence of renal AR was 5 %, lower than other groups (P＜0. 01); in the group of six antigen mismatches, the incidence of AR was 23 %, obviously higher than other groups (P＜0. 01). The 1-year, 5-year and 10-year survival rate was 97 %, 90 %, 88 % in the group of zero antigen mismatches; 94 %, 86 %, 83 % in the group of one antigen mismatches; 94 %, 84 %, 82 % in the group of two antigen mismatches; 93 %,85 %, 81% in the group of three antigen mismatches; 91%, 82 %, 74 % in the group of four antigen mismatches; 90 %, 81%, 72 % in the group of five antigen mismatches; 88 %, 80 %, 70 % in the group of six antigen mismatches. Conclusion Good HLA matching can significantly reduce the incidence of AR of renal allografts and increase the survival rate. If recipients are offered to choose those with HLA antigen mismatches ≤3, it is good for the effective use of donor kidneys, the prevention of rejection, and the improvement of the transplantation results.