Clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney / 器官移植

Objective To evaluate the clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney. Methods Clinical data of pediatric donors (n=10) and adult recipients (n=19) undergoing kidney transplantation were retrospectively analyzed. The changes of renal function, liver function and the maximal diameters of the kidney allografts were compared at 1, 7, 14, 28, 60 d after operation. The short-term survival and incidence of postoperative complications of the recipients were analyzed. Results Ten donors included 6 males and 4 females, aged (7±3) years old, with a body mass index (BMI) of (16.3±3.8) kg/m2. All donors were donation after brain death followed by cardiac death. Among 19 recipients, 12 were males and 7 were females, aged (34±12) years old, with a BMI of (20.3±1.3) kg/m2.An oblique incision was created in the lower right abdomen of the recipients. The arteries and veins of donor kidney were anastomosed with the external iliac arteries and veins of the recipients. The ureter of donor kidney was anastomosed with the bladder of the recipients. After anastomosis, the kidney was placed and fixed in the right iliac fossa. The serum creatinine and blood urea nitrogen levels of the recipients were decreased at 1 week after kidney transplantation, and restored to normal range at postoperative 2 weeks. All parameters related to liver function were normal after operation. At postoperative 1 month, the maximal diameters of the kidney allografts were (9.5±0.3) cm on average, which basically reached those of normal adults. The 1-year survival rate of 19 recipients was 95%. One recipient died from pulmonary infection after ineffective treatment. Two recipients developed rejection, and 1 recipient experienced urinary system infection, who were healed after corresponding treatment. Conclusions Adult kidney transplantation from unilateral pediatric donor kidney is safe, feasible and effective, which can be utilized to enlarge the source of donor kidneys.

Analysis of early clinical efficacy of renal transplantation from extended criteria donor of the donation after cardiac death / 器官移植

Objective To compare the early clinical efficacy of renal transplantation between extended criteria donor (ECD) and standard criteria donor (SCD). Methods Clinical data of 85 recipients undergoing renal transplantation from donation after cardiac death (DCD) were retrospectively analyzed. According to the types of donors, all recipients were divided into the ECD group (n=31) and SCD group (n=54). The level of serum creatinine (Scr), incidence of early complications and clinical prognosis within 3 months after renal transplantation were compared between 2 groups. Results No statistical significance was observed in the levels of Scr within 1 month after renal transplantation between the ECD group and SCD group (all P>0.05). At postoperative 60 and 90 d, the level of Scr in the ECD group was (189±97) and (175± 69) μmol/L respectively, significantly higher than (142±49) and (135±41) μmol/L in the SCD group (P=0.005 and 0.002). In the ECD group and SCD group, the incidence of acute rejection (AR) was 6% and 15%, the incidence of delayed graft function (DGF) was 23% and 19%, the incidence of pulmonary infection was 10% and 6%, the incidence of other early complications was 32% and 15%, respectively, no statistical significance was identified (all P>0.05). In the ECD group and SCD group, the survival rate of the recipient was 97% and 94%, the survival rate of the renal was 84% and 91%, no statistical significance was identified (all P>0.05). Conclusions Compared with the SCD, renal transplantation from ECD can achieve equivalent early clinical efficacy. In the present condition of serious deficiency of donor kidney, the application of ECD can enlarge the supply of the donor kidney.

Sleep quality survey and influencing factors analysis in officers and soldiers stationed and trained at plateau / 重庆医学

Objective To investigate the sleep quality of inland military officers and soldiers stationed and trained at plateau and its possible influence factors.Methods A total of 459 military officers and soldiers stationed and trained at plateau were performed the on site psychological assessment by adopting the psychological stress self-evaluation test (PSET),Pittsburgh Sleep Quality Index (PSQI),work related fatigue feelings (WRFFQ) and self compiled general data questionnaire.Results (1) The mean value of overall sleep quality in militaries stationed and trained at plateau was 5.61-±-3.48.40.5 ％ of respondents had good sleep quality,25.3％ had poor sleep quality and 34.2％ had general sleep quality.(2)The fatigue and psychological stress scores in the militaries with poor sleep quality were significantly higher than those in the militaries with good sleep quality (t1 =10.70,t2 =-9.68,P＜0.01).(3)The psychological stress,fatigue degree,confidence level of self-assessment health status had significantly positive correlation(r =0.517,0.488,0.259,0.352,P＜ 0.01).(4) The psychological stress,fatigue degree,confidence level of self-assessment health status entered the PSQI total score regression equation,moreover the predictive variation amount was 36.1％.Conclusion The psychological stress status and fatigue level in the militaries at plateau affect the sleep quality,and the confidence degree and health status assessment of officers and soldiers on exercise also produce the active influence on sleep.

Clinical study of early infection of multi-drug resistant organisms after renal transplantation from organ donation after citizen's death / 器官移植

Objective To investigate the clinical characteristics, prevention and treatment of multi-drug resistant organisms (MDROs) infection early after renal transplantation from donation after citizen's death. Methods Clinical data of 166 patients undergoing allogeneic renal transplantation and regular follow-up in Xijing Hospital from November 2011 to September 2016 were retrospectively analyzed. General conditions were statistically compared between the recipients undergoing renal transplantation from donation after cardiac death (DCD) and their counterparts receiving living related donor renal transplantation. The incidence of MDROs infection, onset time, course of diseases, complications, infection site and etiological type were observed. The therapeutic methods and clinical prognosis were summarized. Results The incidence of MDROs infection early after renal transplantation in the recipients undergoing DCD renal transplantation was 14%, significantly higher than 2% in those receiving living related donor renal transplantation, and 13% and 2% for the incidence of delayed graft function with statistical significance (both P<0.05). The incidence of renal graft loss was 8%and 2%, and 5% and 1% for the mortality rate without statistical significance between two groups (both P>0.05). MDROs infection occurred in 11 patients after DCD renal transplantation. The most common infection site was urinary system(n=6) and the most prevalent pathogenic bacterium was Escherichia coli (n=4). All patients infected with MDROs were treated with a sufficient dosage of effective antibiotics according to the outcomes of bacterial culture and drug sensitivity test. Eight patients obtained favorable clinical prognosis, one underwent nephrectomy and two died. Conclusions The incidence of MDROs infection early after DCD renal transplantation is higher than that after living related-donor renal transplantation. Strict donor screening, early detection, intimate monitoring and timely treatment can effectively reduce the risk of MDROs and enhance clinical prognosis.

Effect of hypothermia status in donors on renal graft function after renal transplantation from donation after citizen's death / 器官移植

Objective To evaluate the effect of hypothermia status in the donors upon the renal graft function after renal transplantation from donation after citizen's death. Methods Thirty-six eligible donors were randomly divided into the normal temperature (body temperature 36.5-37.5 ℃ , n=19) and hypothermia groups (body temperature 34.0-35.0 ℃ , n=17). The matched recipients undergoing renal transplantation were also assigned into the normal temperature (n=38) and hypothermia groups (n=34). Perioperative conditions of the donors and recipients were compared between two groups. And postoperative renal graft function of the recipients were statistically compared between two groups, including the incidence of delayed graft function (DGF) and primary nonfunction (PNF). Results No statistical significance was identified in the perioperative amount of urine volume, serum creatinine (Scr), systolic blood pressure, saturation oxygen, warm ischemia time and cold ischemia time of the donors between two groups (all P>0.05). No statistical significance was noted in terms of the operation time, intraoperative mean blood glucose and intraoperative mean arterial pressure of the recipients between two groups (all P>0.05). Postoperative incidence of DGF of the recipients in the hypothermia group was 6%, significantly lower than that in the normal temperature group (24%) (χ2=4.393, P=0.036). Postoperative incidence of PNF of the recipients was 3% in both the hypothermia and normal temperature groups with no statistical significance (χ2=0.000, P=1). Conclusions The hypothermia status of the donors can significantly reduce the incidence of DGF, whereas exerts no evident effect upon the incidence of PNF in the recipients.

Application of egg-yolk-antibody to prevent recolonization of Streptococcus mutans / 实用口腔医学杂志

Objective:To investigate the effect of local application of the water soluble protein fraction,containing specific egg yolk antibody,on the recolonization of Streptococcus mutans.Methods:Whole cells of inactivated streptococcus mutans were used as antigen to immunize bens,then water soluble protein fraction(WSF) was extracted from the eggs. Mouth wash containing 0.1 mg/ml of WSF was prepared and administered to 8 volunteers.The mouth wash was used once every two days for 2 weeks.Vehicle solution was used in other 6 volunteers as the control.S.mutans in saliva was monitored for 100 days.Results:Before using the mouth washes,S.mutans level in saliva of the volunteers was 36.4%.S.mutans was removed by hibitane,it kept less than 3% in 100 days in the tested individuals,while 23%～37% in the controls.Conclusion:The WSF containing specific egg yolk antibody can effectively prevent the recolonization of streptococcus mutans.