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Objective To analyze the distribution of microorganisms in kidney perfusion fluid and perirenal drainage of the renal allografts,and provide evidence to guide clinical practice.Methods The clinical data from the kidney donors and the recipients,the microbiologic culture results of kidney perfusion fluid and perirenal drainage were retrospectively analyzed.Results Ninety-one kidney perfusion fluid samples and 91 perirenal drainage samples were collected from 61 individual renal allografts,and 48 renal allografts were paired.Fourteen (15.4％,14/91) cultured kidney perfusion fluid samples were positive,17 strains were confirmed including 13 strains of bacteria and 4 strains of fungal,and 9 (69.2％,9/13) of bacterial strains were multidrug-resistance with 7 strains resistant to carbapenems,but there was no significant heterogeneity in the outcome of recipients with positive or negative culture results of kidney perfusion fluid samples.Eight (8.8％,8/91) perirenal drainage samples from different recipients were positive,5 of 8 bacterial strains were multidrug-resistance and 3 of them were resistant to carbapenems including meropenem or imipenern.There was no significant correlation between the length of donors' hospital stay and the culture results (P＞0.05),and there was also no significant correlation between the length of recipients' hospital stay after transplantation and the culture results (P＞0.05).Conclusion The kidney with positive perfusion fluid microbiologic culture can be transplanted safely using the prophylaxis or preemptive anti-infection therapy.
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Objective To compare the clinical efficacy of kidney transplantations from donors with acute kidney injury (AKI) and without AKI,and summarize the experience of evaluation and application.Methods The clinical data of 240 kidney transplantations from donation after citizen's death (DCD) performed in our hospital between November 2011 and March 2015 were retrospectively analyzed.The recipients were classified into AKI group (n =37) and non-AKI group (n =203) according to donors' renal function and urine output.Basic characteristics and evolution of the donors and recipients were compared between the two groups.Results The donor serum creatinine was significantly higher in the AKI group than that in the non-AKI group (P＜0.01).Most transplant recipients accepted ATG for immune induction therapy in the AKI group,while Basiliximab was given in the non-AKI group,which was significantly different (P＜0.01).Delayed graft function developed more frequently and longer in the AKI group than in the non-AKI group (P＜0.01).However,patient and graft survival rates did no differ between the AKI and non-AKI groups (P＞0.05).There was no significant difference in other indexes between the two groups (P＞0.05).Conclusion The transplants from donors with AKI showed higher incidence of delayed graft function but no effect on 1-year allograft and patient survival.This type of kidney transplantation is safe and effective.
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Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death (DCD).Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection (DTI):1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans (case 2 and case 4),1 case for cryptococcus neoformans (case 1),1 case for klebsiella pneumonia (case 5).No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Conclusion Renal graft artery rupture is one of most severe complications after renal transplantation.It is the key for preventing infectious renal artery rupture to screen strictly infection of donors and recipients,and to use sensitive and wide coverage antimicrobial to the donors before the removal of donor kidney and during the perioperative period after renal transplantation.Early detection and operation as soon as possible is the only treatment to save the lives of the recipients.
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BACKGROUND:Tantalum rod implant technology is a new method of early osteonecrosis treatment. Current research on stress distribution before and after tantalum rod implant in different sizes of femoral head necrosis area is few. OBJECTIVE:To analyze the stress distribution before and after tantalum rod implantation in different sizes of necrotic femoral head area using three-dimensional finite element method. METHODS:Three-dimensional finite element models of normal femoral head and necrotic femoral head of 15, 20 and 30 mm diameterwere constructed. Eight measuring points were chosen on two tiers of each necrotic model to detect the stress distribution and its alteration before and after tantalum rod implantation. RESULTS AND CONCLUSION:(1) Stress concentration werefound on every necrotic femoral head, most pronounced on the one with 30 mm lesion. (2) Tantalum implant appeared to reduce the stress concentration generaly. Comparison of the peak points of these models indicated most significant benefit in 15 mm lesion, next in 30 mm lesion, last in 20 mm lesion. (3) Results indicate that larger lesion entails more concentrated stress distribution and more likely to colapse. Tantalum rod implantation can delay the development of necrosis of the femoral head, andismost effective in smal lesion.
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Objective To investigate relationships between signal/cutoff (S/CO) ratios of antiHCV recombinant immunoblot assay (RIBA) and their positivity with different chemiluminescence immunoassay(CLIA) reagents.Methods A case-control study was performed.From March 2014 to March 2015,anti-HCV antibody was detected in 2 616 serum of outpatients and inpatients coming from Department of Clinical Laboratory,Qilu Hospital of Shandong University by three kinds of homemade CLIA reagents and one imported CLIA reagents.The positive samples were further tested by RIBA.The correlation between the positivity and the S/CO ratios was analyzed.The difference between different reagents were compared by x2 method.Results The predicted positivities of Shandong Laibo were 97.8％ and 33.3％ with S/CO ratio ≥ 26.8 and 1 to 26.8,respectively;The predicted positivities of Beijing Yuande were 96.7％ and 20％ with S/CO ratio ≥ 16.6 and 1 to 16.6,respectively;The predicted positivities of Beijing Kemei were 97.0％ and 9.8％ with S/CO ratio ≥ 16.7 and 1 to16.7,respectively;The predicted positivities of Abbott were 96.9％ and 12.8％ with S/CO ratio≥5 and 1 to 5,respectively.Conclusions Anti-HCV CLIA S/CO ratio and RIBA confirmatory test results have some relevance.Domestic reagents also can refer to import reagents determine the relationship between the positivity and the S/CO ratio.Different domestic reagent of positivity has different S/CO ratio.Although each reagent S/CO ratio to the same positivity has large difference,suggesting each manufacturer should set their products corresponding values according to the situation,providing reference for the clinical use of unit in result determination of the clinical trials.
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Objective To observe the THP for locally advanced breast cancer in recent efficacy and toxicity. Methods 32 patients with locally advanced breast cancer received chemotherapy: THP 50mg/m~2 , intravenous injection; day 1: CTX600mg/m 5 - FU500mg/m~2, ivgtt on day 1 and day 8,for a period of 21 days. Results 73% had efficiency,with small heart poisonous side effects. Conclusion New adjuvant chemotherapy with THP - containing regimen for the treatment of locally advanced breast cancer has a higher efficacy, and adverse reactions can be tolerated.
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@# ObjectiveTo explore clinic features of large cerebral infarction and the relationship between infarcted area and prognosis.MethodsClinic materials such as dangerous factors, onset, course, treatment and prognosis, brain CT changes and internal carotid artery ultrasonic examinations of 68 patients with large cerebral infarction were analyzed retrospectively.ResultsThere were 28 cases caused by cerebral embolism, and 40 cases caused by cerebral thrombosis. 6 cases got recovery, and 34 cases, progress, and 11 cases,no progress, and 17 cases, death. ConclusionThe infarcted area was significantly related to prognosis (P<0.05). Internal carotid artery frequently occurring atheromas and senile non-valve atrial fibrillation were major embolic origins for large cerebral infarction.11 out of the 17 deaths could be attributed to brain herniation and secondary infection. The early abnormal brain CT showed that the rate of mortality was 62.5%, and the rate of mid-line dislocation was 42.9%. Either of them indicated that prognosis was bad.