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Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.
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Objective:To observe the effect of conversion from immediate-release tacrolimus (Tac) to extended-release Tac on kidney function in stable kidney transplant recipients.Methods:83 stable kidney transplant recipients who were converted from immediate-release Tac to extended-release Tac in the second people's hospital of Shanxi province from December 2011 to June 2019 were followed up for 12-36 months, and 83 stable kidney transplant recipients who continued to take immediate-release Tac were selected as control group.The changes of kidney function indexes, Tac trough concentration intra-patient variability (IPV) and compliance, the incidence of rejection and the survival rate of grafts and recipients were observed after the conversion from immediate-release Tac to extended-release Tac in stable kidney transplant recipients.Results:The conversion time from immediate-release Tac to extended-release Tac was (42.76±30.50)months after transplantation. At 24 months after conversion, the serum creatinine (SCr) was significantly lower than that before conversion ( P=0.013), and the estimated glomerular filtration rate(eGFR)was significantly higher than that before conversion( P=0.005). In the experimental group , the SCr was significantly lower than that of the control group at 36 months after conversion ( P= 0.017), eGFR was significantly higher than that of the control group ( P=0.038). In the experimental group, the score of Immunosuppressant Therapy Barrier Scale (ITBS) was (20.23±2.89) before conversion and (17.63 ±3.08) after conversion ( P= 0.000). The daily dose of Tac was (2.09 ±0.84) mg before conversion and (2.10 ±0.83) mg after conversion. The trough concentration of Tac before conversion was (7.22 ±2.84) ng/mL, which reduced significantly after conversion. No rejection occurred after conversion, and the recipients/grafts survived healthily during the follow-up period. Conclusions:After conversion from immediate-release Tac to extended-release Tac in stable kidney transplant recipients, the kidney function is stable and better than that of before conversion, the compliance is significantly improved, the IPV of Tac trough concentration is significantly reduced, and long-term use of extended-release Tac has good clinical efficacy and safety.
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Objective To investigate the effect of asymptomatic hyperuricemia after renal transplantation on renal function of the grafts.Methods The follow-up data were retrospectively collected and analyzed in 144 patients with renal transplantation from January 2010 to March 2015.The patients were classified into three groups according to the level of serum uric acid (SUA):group A (normal group),group B (asymptomatic hyperuricernia with average SUA less than or equal to 360 μmol/L after treatment),and group C (asymptomatic hyperuricemia with average SUA greater than 360μmol/L after treatment).The renal function indexes such as serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were compared among three groups from 12 to 48 months after transplantation.Results The SCr and eGFR showed no significant difference between group A and group B at 12th month (P＞0.05),but ther are superior than Group Ⅲ (P＜0.05).Conclusion After renal transplantation,asymptomatic hyperuricemia can lead to impaired renal function,and there are no significant differences in renal function between renal transplant recipients with normal SUA levels after treatment and those without hyperuricemia.
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Objective To observe the change in IL-1β,IL-13mRNA expression in drowning rat lungs and serum,so as to investigate the significance of IL-1β and IL-13 mechanism in the development of drowning.Methods SD rats were randomly divided into control group,drowning group.Then using TaqMan probe method to determine the expression of IL-1β and IL-13 mRNA in Right lower lobe of lung tissue and the serum of right ventricle,which were extracted respectively from each group of rats.Results (1) The lung tissue morphological changes:Typical appearance signs and anatomy of drowning group meet ante-mortem drowning feature.(2) The expression of IL-1β,IL-13 in lung tissue:compared with the control group,the expression of IL-1β and IL-13 were slightly decreased,which has no statistical significance.(3) The expression of IL-1β and IL-13 in serum:compared with the control group,the expression of IL-1β and IL-13 were significant increased,both of which has statistical significance.Conclusion (1)The expression of IL-1β and IL-13 were decreased in lung tissue may be due to drowned rats present compensatory anti-inflammatory response syndrome which causes immune incompetent performance.(2) The expression of IL-1β and IL-13 were significant increased in serum may be relate to drown stress and drowning associated acute lung injury after traumatic stress.
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Objective To explore the changes of mineral and bone metabolism before and after renal transplantation as well as the effect of preoperative parathyroid hormone (PTH) level on postoperative mineral and bone metabolism.Methods In this retrospective analysis,we recruited 82 cases of renal transplant recipients with normal renal function and receiving kidney transplantation in our hospital from January 2011 to January 2015.All of these patients had intact PTH (iPTH) level ＞300 pg/mL.We chose 26 cases of recipients whose preoperative iPTH was more than or equal to 800 pg/mL as very high PTH group,and 56 cases of recipients whose preoperative iPTH was between 301-799 pg/mL as high PTH group.We monitored and performed analysis of the total serum calcium (Ca),serum inorganic phosphorus (P),25-(hydroxyl) vitamin D3 (25 OHD),serum alkaline phosphatase (ALP),Beta C-terminal telopeptide (β-CTX),N-terminal/midregion (N-MID) pre-and 1 month,4 months,1 year,2 years,3 years post-kidney transplantation.Results Serum total calcium in the two groups was gradually increased,returned to normal range 1 month post-transplantation and reached the plateau 4 months post-transplantation.The incidence of hypercalcemia in very high PTH group was statistically significantly higher than in high PTH group.Serum phosphorus in the two groups showed a trend of gradual decline after renal transplantation,and returned to the normal range 1 month post-transplantation.The serum phosphorus level in very high PTH group reached the plateau 4 months post-transplantation,and that in high PTH group 1 month post-transplantation.Compared with high PTH group,very high PTH group has greater The incidence of long-term hypophosphatemia after renal transplantation was significantly higher in very high PTH group then in high PTH group.iPTH,ALP,β-CTX and N-MID in the two groups showed a downward trend after renal transplantation.At first month post-transplantation,iPTH,ALP,β-CTX and N-MID levels were reduced most significantly.The average levels of the three mentioned indicators in very high PTH group were higher than in high PTH group at every time point after surgery with the difference being significant during the early post-transplantation period.The anomalies of iPTH and β-CTX levels persisted to long term after transplantation in very high PTH group.25-OHD levels in these two groups showed rising trend after renal transplantation,reached the plateau 4 months posttransplantation,but failed to achieve the ideal reference level,and no significant difference was found between two groups at any time point monitored.Conclusion The anomalies of mineral and bone metabolism after renal transplantation could persist a long time.Conclusion hyperparathyroidism in the renal transplantation plays an important role in mineral and bone metabolism.Preoperative severe HPT could continue to post-transplantation period and increase the incidence of hyperphosphatemia and hypocalcemia long term after transplantation,which may aggravate bone turnover and this effect can last a long time after transplantation.
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Objective To investigate the effect and safety of transcutaneous electrical stimulation at Zusanli acupoint for elimination of gastrointestinal poison in patients with oral organophosphorus pesticide poisoning. Methods A prospective study was conducted, including 62 patients with oral organophosphorus pesticide poisoning from September 2013 to February 2015 in the Department of Emergency of Xingtai People's Hospital of Hebei Province. The patients were divided into a observation group and a control group (each, 31 cases) in accord with the principle of simple random sampling. All the patients in two groups were given comprehensive treatment according to the diagnosis and treatment of the guide for organic phosphorus pesticide poisoning. In addition, the transcutaneous electrical stimulation at bilateral Zusanli acupoints was carried out in the observation group, once therapeutic time 30 minutes and every 8 hours once, and stopped until the discharge of melena. The incidence of vomiting after application of cathartics, the first stool time, the time of melena discharge, daily defecation frequency, the time of reaching atropinization, the total amount of atropine used, the time of cholinesterase (ChE) activity returning to its 1/2 normal activity, the length of stay in hospital, cure rate and mortality were observed in both groups. The changes in hemodynamics and pulse blood oxygen saturation (SpO2) were observed before and after transcutaneous electrical acupoint stimulation, and the occurrence of adverse reactions in the therapeutic course were observed in the observation group.Results After application of cathartics, the incidence of vomiting in control group was significantly higher than that in the observation group [32.2% (10/31) vs. 9.7% (3/31),P < 0.05]. In the observation group, the first stool time (hours: 9.3±3.6 vs. 11.6±5.2) and the time of melena discharge (hours: 11.3±5.3 vs. 14.5±6.8) were significantly shorter than those in the control group (both P < 0.05); while the frequency of bowel movements during catharsis was higher than that of the control group (times/d: 4.3±0.5 vs. 3.1±0.4,P < 0.01). In the observation group, the time reaching atropinization (hours: 66.3±22.8 vs. 84.6±24.2), the total amount of atropine used (mg: 66.3±22.8 vs. 84.6±24.2), and the time of ChE activity returning to its 1/2 normal range (days: 6.1±2.4 vs. 8.3±3.9) were significantly shorter than those in the control group (allP < 0.01). At the end of treatment, the average length of stay in hospital was shorter (days: 11.3±2.8 vs. 13.4±4.2,P < 0.05) and the cure rate was higher [96.8% (30/31) vs. 83.9% (26/31),P < 0.05] in the observation group than those in the control group; in observation group, the hemodynamics and SpO2 before and after acupoint electrical stimulation did not change significantly; in the course of treatment, no adverse reactions occurred.Conclusion The addition of transcutaneous electric stimulation at bilateral Zusanli acupoints in patients with oral organophosphorus pesticide poisoning has following advantages: lowering the incidence of vomiting during catharsis, enhancing the cathartic effect, promoting gastrointestinal poisoning discharge as soon as possible, reducing total atropine used during hospitalization, shortening the time reaching atropinization, shortening the duration of hospitalization, promoting the recovery of cholinesterase activity and elevating clinical therapeutic effects.
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OBJECTIVE@#To investigate effect and safty evaluation of stellate ganglion catheter retention with discontinuous block on sudden deafness.@*METHOD@#One hundred and twenty-six patiens with sudden monaural deafness were randomly divided into Catheterp and block and control groups with 42 cases in each group. All patients' throats were given conventional blood activating drugs, hormone and hyperbaric oxygen therapy. stellate ganglion puncture retained catheter were administrated to the patients in catheter group followed by ropivacaine block 1 times/day, block group stellate ganglion puncture and ropivacaine block 1 times/day. The patients in control group were only received routine comprehensive treatment. Patients in both catheter group and block groups were treated by hyperbaric oxygen therapy after the block treatment. Curative effects of three groups were observed. The patients' satisfaction, heart rate, the chages of blood pressure before and after the block, detachment of tubes, and adverse drug reaction were recorded.@*RESULT@#The effect of the treatment in both catheter group, block group was better than in control group (85.7%, 37 cases); 83.3%, 35 cases) vs 64.3%, 27 cases, P < 0.05). The satisfactory rate in the patients in catheter group was significantly higher than block group (83.3%, 35 cases vs 61.9%, 26 cases, P < 0.05). The heart rate and the blood pressure before and 5 minutes after catheterization in catheter group and block groupwere changed obviously. Moreover, no adverse drug reaction and detachment of tubes were observed.@*CONCLUSION@#It is a safe and effective administration of stellate ganglion catheter retention with interrupted ropivacaine block.
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Humans , Amides , Therapeutic Uses , Autonomic Nerve Block , Methods , Blood Pressure , Catheterization , Catheters , Hearing Loss, Sudden , General Surgery , Heart Rate , Hyperbaric Oxygenation , Ropivacaine , Stellate Ganglion , General SurgeryABSTRACT
Objective To summarize the safety and efficacy of low dose of hepatitis B immunoglobulin (HBIG) for prevention of de novo hepatitis B infection after renal transplantation.MethodsThe clinical data of 138 patients who received renal transplantation without hepatitis B infection between January 2007 and June 2010 were retrospectively studied (study group).All the patients in study group were given low dose of HBIG injection before transplantation.The HBsAb titer was monitored regularly after transplantation,and the dosage of HBIG adjusted according to the level of the HBsAb titer.HBIG was implied to all patients in the study group for more than one year.The clinical data of 196 patients who received renal transplantation without hepatitis B infection between January 2004 and December 2006 served as the control group.These 196 patients were not treated with HBIG.The incidence of de novo hepatitis B infection,and acute rejection of these two groups was analyzed.The one-year graft and patients survival rate was also investigated.Results During the follow- up period of 12 months,only one case in the study group had de novo hepatitis B infection (0.7％) 6 months after renal transplantation,while 11 cases (5.6％) in the control group had de novo hepatitis B infection,in which 2 cases were died from acute hepatic failure.The incidence of de novo hepatitis B infection had statistically difference between the two groups (P＜0.05).The incidence of acute rejection in the study and control groups was 13.8％ and 17.3％ respectively (P＞0.05).The one-year graft and patient survival rate in the study and control groups was 96.4％ and 97.8％,and 90.3％ and 91.8％ respectively (P＜0.05).ConclusionLow dose of HBIG is effective and safe for prevention of de novo hepatitis B infection after renal transplantation.
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OBJECTIVE:To prepare Shuansaitong capsules and establish a method for its quality control.METHODS: Distillation method was applied to extract volatile oil from volatile oil-containing medical material and water decoction method was used to extract physic liquor from other medical material. Suitable quantity of excipients was added to prepare Shuansaitong capsules.Qualitative identifications of Ligusticum chuanxiong,Panax quinquefolium,Salvia miltiorrhiza,Angelica sisensis were performed by TLC,and the content of Gastrodin was determined by HPLC.RESULTS:The quality of Shuansaitong capsules was completely in conformity with the related requirements of China Pharmacopeia.The TLC spots were clear,well-separated,specific and free from interferonce of negative sample.The linear range of gastrodin was 0.1～0.5 ?g with a correlation coefficient of 0.999 5.The average recovery was 96.59% with RSD=0.47% (n=6).CONCLUSION:The preparation technology of Shuansaitong capsules is simple and the determination result was accurate,thus suitable for the preparation and quality control of Shuansaitong capsules.
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Objective To study the expression of matrix metalloproteinase(MMP)-2,9 and tissue inhibitor of metalloproteinase(TIMP)-1,2 protein in human endometrial carcinoma tissue and its relation to the invasion and metastasis of endometrial carcinoma. Methods Immunocytochemistry and zymography techniques were used to measure the MMP-2,MMP-9,TIMP-1,TIMP-2 protein levels and activities in endometrial carcinoma tissue of 37 patients and control group composed of 7 normal postmenstrual endometrial samples. Results The MMP-2,MMP-9,TIMP-1 and TIMP-2 proteins mainly expressed in endometrial carcinoma cells, glandular cells and endothelial cells. The strongly positive expression proportions of MMP-2,9 and TIMP-1 proteins in grade Ⅲ carcinoma cells were respectively 73%, 20% and 67%, which were higher than those in gradeⅡ (13%, 0, 27%) and gradeⅠ (0) ones ( P
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Objective To explore the relationship between interleukin-1?(IL-1?) and group Ⅱ metabotropic glutamate receptors(mGluR2/3). Methods The rats were randomly divided into five groups:1
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Objective In order to explore the action of IL-1? involved in epileptogensis,the changes of Gs? expression were studied in hippocampus of epileptic rats induced by sodium glutamate. Methods Immunohistochemical staining and animal behaviours were observed during the experiments.Healthy adult SD rats were divided randomly into five groups:1.Control.2.GluNa group.3.IL-1?+GluNa group.4.rhIL-1ra+IL-1?+GluNa group.5.D-AP-5+IL-1?+GluNa group. Results The changes of behaviours showed that latent period of seizure in IL-1?+GluNa group was reduced remarkly compared with that of other groups;the degrees of seizure were more serious than that of other groups.The results of immuohistochemistry showed that immunoreaction of Gs? was obviously enhanced in hippocampal CA1,CA3 areas and dentate gyrus of IL-1?+GluNa group compared with other groups.Conclusion IL-1? may play an important role in medicating pathologenesis procession of epilepsy induced by glutamate and make effect by stimulating overexpression of Gs protein.