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The rationality evaluation of construction project cost covers the whole process of construction project management. It is of great significance to identify and control the errors of compiled cost in time, which assists in improving the investment benefit of construction projects. This paper aims to address the shortcomings of the foundation and methods for the traditional cost evaluation. First, the construction engineering characteristic index is constructed, and the data similar to the project to be reviewed is identified from the large-sample-size data of the engineering projects by fuzzy C-means clustering, which is used as the training sample. Second, considering the nonlinearity of cost characteristic index and project cost, LSSVM is used to develop a prediction model for sample training. Finally, the prediction model is applied to analyze the cost prediction interval of the project to be reviewed, and the evaluation is completed by judging whether the construction value of the project to be reviewed is within the cost prediction interval. The results show that FCM clustering can identify similar engineering samples quickly and effectively. This evaluation model can improve the efficiency and reliability of construction cost evaluation. [ABSTRACT FROM AUTHOR]

Firstly, an optimization model was proposed for single airports ground-holding problem, in which the factors concerning the different delay costs of different planes and delay time of flights with continuation of the journeys. Moreover, the proposed model can reasonably and effectively assign multiple independently-running runways to meet the operating demand of large busy airports. Then an adaptive multi-local search memetic algorithm was designed to solve this model. In view of complexity of the model, poor convergence and optimizing ability that single local search memetic algorithm manifests when solving complicated problem, different local search strategies were used at different stages in proposed adaptive multi-local search memetic algorithm, among them adaptive directed local search strategy adjusted individual searching speed according to messages of the individual, best individual and population. Finally the simulation was implemented with the data in many examples, experimental results show that, compared with the results of other representative algorithms, the validity of the proposed algorithm and model. [ABSTRACT FROM AUTHOR]

This study aims to explore the key factors influencing the processing of braised Rehmanniae Radix, optimize the processing, and determine the correlation between the components in different processed products and chroma values, which is expected to add quantitative indexes for the processing of braised Rehmanniae Radix and better control the processing. The weights of the indexes catalpol, rehmannioside D, verbascoside, isoacteoside, 5-hydroxymethylfurfural, reducing sugar, and appearance were calculated based on analytic hierarchy process(AHP) in combination with coefficient of variation, and the overall desirability(OD) was obtained. Box-Behnken design was used to explore the optimal amount of water added, time for soaking with rice wine, and steaming time in the processing of braised Rehmanniae Radix. Colorimeter was employed to determine the chroma of 17 samples and raw samples, and SPSS, Prism, and other software to investigate the correlation between the components in braised Rehmanniae Radix and the chroma values. The results showed that each factor influenced the processing, and the influence followed the order of steaming time>amount of water added>time for soaking with rice wine. The optimal processing process is as below: A total of 100 g medicinal material was added with 7 times of water, followed by soaking with rice wine for 5 h and steaming in a pot for 6 h. The correlation analysis suggested the extremely significantly positive correlation between L~* and content of catalpol, between a~* and 5-hydroxymethylfurfural content, and between b~* and catalpol content, and the extremely significantly negative correlation between L~* and the content of 5-hydroxymethylfurfural and reducing sugar, and between b~* and the content of 5-hydroxymethylfural and reducing sugar. In this experiment, response surface methodology was used to optimize the processing technology of braised Rehmanniae Radix and the optimized process was rational and feasible. The content of chemical components in braised Rehmanniae Radix was significantly correlated with the chroma. This study provided a new method for the quality evaluation of braised Rehmanniae Radix.

Objective: To discuss the characteristics of physician trainee outcomes after completion of the job-transfer subspecialty training in pediatrics, a program designed to increase the number of pediatricians, in Sichuan Province and to provide countermeasures for alleviating the shortage of pediatricians., Methods: We collected with questionnaire surveys information on changes in the workload and salaries experienced by physicians who completed the job-transfer subspecialty training program in pediatrics between February 2017 and May 2020 in Sichuan Province. Then, we compared the characteristics of physicians who successful became pediatricians and those who did no., Results: A total of 208 physicians completed the job-transfer subspecialty training program in pediatrics. Among them, 178, accounting for 85.6%, completed the questionnaire survey, and 120, accounting for 67.4%, had a background in other subspecialties than pediatrics. The majority (>90%) of physicians who participated in the training program came from secondary or lower levels of hospitals from the cities and prefectures all over Sichuan Province. In this study, we found that the rate of successful job transfer from being a physician to being a pediatrician in Sichuan Province in the past four years was 85.0% (102/120), with the year-by-year results being 88.2% (15/17) in 2017, 72.7% (16/22) in 2018, 86.7% (39/45) in 2019, and 94.% (32/34) in 2020. There was no significant difference between physicians who had successful job transfer and became pediatricians and those who failed to do so in terms of gender, age, hospital level, specialization prior to the job transfer, whether or not the hospital had a pediatrics department, amount of support for the pediatrics department, whether or not the physician was working at a new hospital after the job transfer, salaries, and changes of responsibilities during COVID-19 (all P >0.05). There was significant difference in the change of workload after completion of the training program between physicians who had successful job transfer and became pediatricians and those who failed to do so ( χ 2 =9.037, P =0.003), and 78.4% of the trainees stated that their workload had increased after the job transfer. There was a moderate correlation between successful job transfer and changes in workload after the transfer (|Phi[ψ] |=0.729)., Conclusions: The policy of government-supported job-transfer subspecialty training in pediatrics has played an active and important role in the swift resolution of the shortage of pediatricians. However, finding the root cause of and addressing the problem of the overwhelming workload of pediatricians remain challenging issues to be resolved., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Objective: To systematically evaluate the efficacy of rapid prototyping drill navigation template-assisted pedicle screw fixation and traditional anatomic landmark-based fixation in the treatment of spinal disease by accessing and searching some relevant literatures home and abroad., Methods: Randomized Controlled Trials (RCTs) and prospective case-control studies or retrospective case-control studies about rapid prototyping drill templates-assisted pedicle screw fixation and traditional anatomic landmark-based fixation for the treatment of spinal disease were searched electronically in PubMed, The Cochrane Library(Issue 5, 2017), Clinical Trial, Google Scholar, Web of Science, CNKI, Wanfang database and VIP database before June 2017. According to the inclusion and exclusion criteria, two researchers independently screened the literatures, and extracted the data. The methodological quality of randomized controlled trials were evaluated by the Cochrane Handbook, and prospective case-control studies and retrospective case-control studies were evaluated by the NOS scale. The outcomes were analyzed using RevMan 5.3 software provided by the Cochrane information management system., Results: A total of 7 articles were included, including 2 RCTs, 1 prospective case-control study and 4 retrospective case-control studies. A total of 237 patients were implanted with 1 688 pedicle screws, including 898 screws in the navigation template group, 790 screws in the conventional method group. Meta-analysis results showed that there was significant difference in the excellent rate of screw implantation between navigation template group and conventional method group [OR=5.05, 95% CI(3.13, 8.16), P <0.000 01], there was significant difference in operative time, intraoperative blood loss for thoracolumbar surgery [WMD=-27.19, 95% CI(-38.21, -16.17), P <0.000 01; WMD=-100.82, 95% CI(-182.26, -19.37), P =0.02]., Conclusions: Compared with traditional pedicle screw fixation, navigation template spine pedicle screw fixation has better clinical effect, which can improve the excellent rate of screw placement, reduce the operation time and intraoperative bleeding., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

The cervical screw fixation has been used widely in the clinic setting due to the high fusion rate, immediate fixation of the surgical segment and good correction of the deformity. However, owing to the variation of anatomical structures and the narrow pedicle screws, it's rather difficult to implant the screws through traditional methods. The perforation rate of the screw is high, which can cause serious complications such as neurovascular injury. In recent years, rapid prototyping navigation templates have been reported in the appilication to assist cervical screw placement for improving the accuracy of screw placement. In this paper, we reviewed and summarized published literatures about navigation template assisted cervical screw implantation in the past 20 years, systematically introduced the methods of producing and using of navigation templates, the development of design concept and the status of application in cervical spine surgery. To date, relevant clinical and cadaveric studies confirm that the use of rapid prototyping navigation template assisted cervical screw placement in cervical surgery can reduce screw perforation rate, intraoperative ionizing radiation injury and operation time, which is worth applying in the clinical practice. However, specific clinical effects of different design types of navigation templates are not well summarized. As a result, more clinical and cadaveric studies comparing the accuracy and safety of navigation templates of different design types are needed to help clinicians select the appropriate navigation template for surgery., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To systematically evaluate the clinical effect of high frequency repeated transcranial magnetic stimulation(HF rTMS)therapy on dyskinesia in patients with incomplete spinal cord injury., Methods: Randomized controlled trials(RCTs) about HF rTMS therapy on patients with motor incomplete spinal cord injury were searched electronically in PubMed, Google scholar, Cochrane library, Clinical trial, Medline, Web of science, CNKI, VIP, and Wanfang database before October 2016. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, as well as extracted the data and assessed the methodological quality. The observed outcomes included ASIA motor score, ASIA lower extremities motor score(LEMS), Modified Ashworth score (MAS), Ten-meter walking test (10MWT) and Walking index for SCI II(WISCI II), and the outcomes were analyzed using RevMan5.2 software provided by the Cochrane information management system., Results: Five RCTs involved 103 patients were included, and 61 patients(experimental group) accepted real rTMS and physical rehabilitation care for SCI, 51 patients(control group) accepted only physical rehabilitation care. There were significant differences in ASIA motor score, LEMS and 10MWT between two groups after HF rTMS therapy (statistics were Z =2.96, P =0.003; Z =3.04, P =0.002; Z =2.16, P =0.03; respectively). When stimulating the leg motor cortex, there was significant difference in MAS between two groups( Z =2.79, P =0.005), and when stimulating the vertex, there was no significant difference( Z =0.09, P =0.93). There was no significant difference in WISCI IIscore after HF rTMS therapy between two groups( Z =0.90, P =0.37)., Conclusions: HF rTMS can raise motor score in patients with incomplete spinal cord injury, improve the spasticity of the lower extremities, and increase the motor ability., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To study the change trend of cervical range of motion(ROM) after single-level anterior cervical corpectomy and fusion(ACCF) in treating cervical spondylotic myelopathy., Methods: The clinical data of 23 patients with cervical spondylotic myelopathy was retrospectively analyzed from February 2015 to April 2016. There were 11 males and 12 females, with an average age of (54.6±13.3) years. All the patients were diagnosed as cervical spondylotic myelopathy by interrogation, physical examination and radiology, and were treated by ACCF. The Coda motion system was applied to assess the cervical range of motion pre-and post-operation. JOA and VAS scores were used to evaluate the clinical outcomes., Results: The mean follow-up time was (9.4±1.6) months. Cervical ROM in all directions at 3 months postoperatively were significantly lower except for the left rotation( P <0.05). There was significant difference of cervical ROM in all directions between preoperative and 6 months postoperatively( P >0.05). The right lateral bending and the left rotation at 9 months postoperatively increased significantly( P <0.05). Postoperative extension at 6 months was significantly better than that of 3 months postoperatively( P <0.05). The extension, left and right lateral bending and left rotation at 9 months postoperatively were significantly better than of 6 months postoperatively( P <0.05). Postoperative JOA scores at each time points were significantly higher than that of preoperative( P <0.05) and VAS scores at each time points were significantly lower than that of preoperative( P <0.05)., Conclusions: The change trend of three-dimensional cervical ROM after single-level ACCF revealed that the ROM decreased in short term, and later increased and was better than the preoperative level. Meanwhile, the neurological function improved significantly. But the short-term and long-term change trend of ROM postoperatively and the change trend of ROM after multi-level ACCF need to be further studied., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To investigate the optimal time window for intervention of BK virus (BKV) replication and its effect on the outcomes of kidney transplant recipients (KTRs)., Methods: A retrospective analysis of the clinical data and treatment regimens was conducted among KTRs whose urine BKV load was ≥1.0×10 4 copies/mL following the operation between April, 2000 and April, 2015. KTRs with urine BKV load <1.0×10 4 copies/mL matched for transplantation time served as the control group., Results: A total of 54 recipients positive for urine BKV were included in the analysis. According to urine BKV load, the recipients were divided into 3 groups: group A with urine BKV load of 1.0×10 4 -1.0×10 7 copies/mL (n=22), group B with urine BKV load >1.0×10 7 copies/mL (n=24), and group C with plasma BKV load ≥1.0×10 4 copies/mL (n=8); 47 recipients were included in the control group. During the follow-up for 3.2-34.5 months, the urine and plasma BKV load was obviously lowered after intervention in all the 54 BKV-positive recipients (P<0.05). Eighteen (81.82%) of the recipients in group A and 19 (79.17%) in group B showed stable or improved estimated glomerular filtration rate (eGFR) after the intervention; in group C, 4 recipients (50%) showed stable eGFR after the intervention. In the last follow-up, the recipients in groups A and B showed similar eGFR with the control group (P>0.05), but in group C, eGFR was significantly lower than that of the control group (P=0.001). The recipients in group A and the control group had the best allograft outcome with stable or improved eGFR., Conclusion: Early intervention of BKV replication (urine BKV load ≥1.0×10 4 copies/mL) in KTRs with appropriate immunosuppression reduction can be helpful for stabilizing the allograft function and improving the long-term outcomes.

Objective: To compare the accuracy of serological and molecular approaches to identification of RhD-negative patients waiting for kidney transplantation., Methods: A total of 103 RhD-negative blood samples by serological test were collected from patients waiting for kidney transplantation between January, 2006 and January, 2016. Quantitative PCR and sequencing were used to verify the results of RHD genotyping, and the false negative rates of the serological and molecular methods for RhD genotyping were compared., Results: Among the 103 blood samples, true RhD negativity (with all the 10 exons missing) was found in 56 samples (54.5%), and false RhD negativity (RhD positivity with loss, repetition, or missense mutation in the 10 exons) in 47 samples (45.6%). In the 47 false RhD-negative cases, weak D was detected in 1 case (2.1%), partial D in 13 cases (27.7%), and D-elution in 33 cases (70.2%). The detection rates of RhD negativity differed significantly between the serological and molecular methods (P<0.05)., Conclusion: Serological test is associated with a high false negative rate in detecting RhD blood group, and the use of the molecular approach has important clinical significance in accurate RhD genotyping for patients waiting for renal transplantation.

Objective: To investigate the significance of Tp-Te interval for risk stratification of ventricular premature contractions (VPC) in children., Methods: A total of 120 children with VPC were divided into benign VPC (n=40), organic disease (n=40) and ventricular parasystole groups (n=40) according to the etiology of VPC; another 40 children who underwent physical examination were selected as the normal control group. The four groups were compared in terms of Tp-Te intervals and Tp-Te/QT ratios in leads V3, V4 and V5., Results: The Tp-Te interval in lead V3 was significantly longer in the organic disease group than in the other groups (P<0.05), the benign VPC group had a significantly shorter Tp-Te interval in lead V4 than the normal control and organic disease groups (P<0.05), and the organic disease group had a significantly longer Tp-Te interval in lead V5 than the benign VPC group (P<0.05). The Tp-Te/QT ratios in leads V3-V5 were significantly higher in the organic disease group than in the other groups (P<0.05). The Tp-Te/QT ratios in leads V4 and V5 showed significant differences between the ventricular parasystole and benign VPC groups (P<0.05)., Conclusions: Tp-Te interval is susceptible to changes in heart rate, and it is of little value for the risk stratification of VPC in children. Tp-Te/QT ratio, however, may be used as an important non-invasive index for clinical risk stratification of VPC in children and is worthy of further study.

Objective: To explore the value of apparent diffusion coefficient (ADC) ratio in the diagnosis of bladder cancer pre-operation by analyzing its differences among different grades of bladder cancer., Methods: A total of 52 cases of bladder cancer were all definitely diagnosed with histological results.Routine examinations of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) were performed preoperatively on each patient. ADC map was constructed in work station and ADC values of tumor and internal obturator muscle were measured (b = 800 s/mm(2)).Ratio of ADC was calculated with internal obturator muscle as reference site. Then the relationship between ADC ratio and bladder cancer grade was analyzed., Results: Mean ratio of ADC of all tumors was 0.98±0.35, G1 (1.12±0.21) and G2 (0.67±0.29), the sensitivity and specificity of ADC ratio was 90.2% and 85.3% respectively with an optimal threshold of 0.96. The ratios of ADC of low-grade group were significantly higher than those of high-grade group while the values of non-muscle-invasive group were significantly higher than those of muscle-invasive group. The ratios of ADC of tumor were inversely associated with the malignancy degree of bladder cancer (r = -0.845, P < 0.05)., Conclusion: The ratio of ADC of bladder cancer reflects the lesion tissue properties. And its measurement plays an important role in the diagnosis of bladder cancer grading pre-operation.

Objective: To identify the risk factors for accelerated junctional escape rhythm (AJER) in children early after percutaneous ventricular septal defect (VSD) closure., Methods: A retrospective controlled study was conducted on 42 children who had AJER within one week after percutaneous VSD closure between January 2008 and October 2012. These subjects were compared with controls without AJER after VSD closure in terms of age, sex, diameter of VSD, occluder size, difference between occluder size and diameter of VSD, and distance between VSD and aortic valve ring. Risk factors for AJER were identified by logistic regression analysis., Results: Compared with the control group, the AJER group had a longer distance betweenVSD and aortic valve ring, a larger diameter of VSD (basal diameter), a larger occluder size (waist diameter) , and a bigger difference between the waist diameter of occluder and diameter of VSD (P<0.05). Logistic regression analysis showed that distance between VSD and aortic valve ring (OR=1.813, P<0.05) and occluder size (OR=1.671, P<0.05) are primary risk factors for AJER., Conclusions: AJER early after percutaneous VSD closure is related to diameter of VSD, occluder size, difference between the waist diameter of occluder and diameter of VSD, and distance between VSD and aortic valve ring. The distance between VSD and aortic valve ring and occluder size are primary risk factors for AJER.

Objective: To investigate the effect of different operation time to percutaneous balloon pulmonic valvuloplasty (PBPV) to critical pulmonary valve stenosis (CPS)., Method: Twenty-one infants (age ≤ 60 days at operating day) suffered from CPS, diagnosed by fetal echocardiogram and confirmed by echocardiography after birth, were enrolled in this case-control-study with written informed consent during April 2007 to December 2011. Of the 21 cases, 7 had prenatal diagnosis in our prenatal diagnosis center (prenatal group, Pre) and 14 were referred from other hospitals, who were divided into postpartum group A (Post A, referred within 28 days after birth) and postpartum group B (Post B, referred 29 to 60 days after birth). To Pre-group, the integrative interventional protocol was cautiously made by the consultative specialists, including intrauterine diagnosis, perinatal care and urgent PBPV soon after birth. To Post-group, emergency PBPV was preformed after the referral. Tei index of right ventricular and pressure-gradient (PG) between right ventricular and pulmonary artery were measured before and at different time points one year after PBPV., Result: The values of SpO2 in Pre-group ranged from 82%-92% (86.57% ± 5.34%) under the state of continuous intravenous infusion of alprostadil. PBPV was successfully preformed within 3-6 days after birth. The values of SpO2 increased to 97.33% ± 1.15% post procedure. The values of PG pre- and post- procedure were (86.34 ± 11.77) mm Hg and (31.43 ± 8.46) mm Hg respectively. Preoperative RV Tei-index was 0.68 ± 0.05, it decreased rapidly after procedure, and recovered to normal one month after procedure. Only one case showed restenosis seven months after procedure and repeated PBPV. Fourteen referral cases (6 cases in Post A group and 8 cases in Post B group, accompanied in 1 and 3 cases with heart failure), the values of SpO2 ranged from 83%-91% under state of continuous intravenous infusion of alprostadil. And the operating time was 10-57 days after birth. The values of SpO2 recovered to normal post procedure, and heart failure alleviated. Increased preoperative RV pressure obviously decreased significantly post-procedure. And increased Tei-index declined gradually, at one-year follow-up, the value of Tei-index in Post A group recovered to normal, whereas that of Post B was (0.51 ± 0.06), compared to Pre and Post A groups, the difference was significant (P < 0.05) . One case showed restenosis nine months after procedure and repeated PBPV was performed. The hypoxic exposure durations were (4.43 ± 0.68) , (16.33 ± 4.46) , (41.25 ± 9.19) , respectively, and the difference among the three groups was significant (P < 0.05)., Conclusion: To the fetuses with definite prenatal diagnosis of critical pulmonary valve stenosis, preoperative general condition can be adjusted to more suitable for emergency operation. Early PBPV can achieve shorter hypoxic exposure and better recovery of right ventricular function post procedure. Perinatal integrated intervention for CPS can significantly improve the prognosis and quality of life in this patient population.

Laser tweezers Raman spectroscopy can help with observing and studying individual cells or organelles in a natural state for a relatively long period. In the present experiment, Laser tweezers Raman spectroscopy (LTRS) was used as a tool to report physiological metabolism such as cells growth and nucleic acid, proteins, lipid and glucose of a single active cold-adapted Aromatic hydrocarbons-degradating strains isolated from Antarctic Sea. After the Raman spectrum was collected and analyzed, the findings are as follows: Raman spectrum identified the components of a single cold-adapted Aromatic hydrocarbons-degradating strain and there were more proteins and carbohydrate produced during the Planococcus sp. NJ41 and Shewanella sp. NJ49 growth and degradation; but there was more lipid than the proteins produced during the Pseudoalteromonas sp. NJ289 growth and degradation; the amount of proteins produced by the strains corresponds with the production of degradation rate-limiting enzyme, and was also related to the capacity of low-temperature degradation of aromatic hydrocarbons.

Objective: To summarize the features of pulmonary infection (PI) in kidney transplant (Ktx) and liver transplant (Ltx) recipients for effective control measures., Methods: A retrospective analysis was conducted among Ktx recipients and Ltx recipients with PI during the period from Jan 2004 to Dec 2008. The clinical data concerning the infection was compared., Results: Forty-five Ktx recipients and 23 Ltx recipients developed PI after the transplantation. The incidence of PI was 7.4% and 56.1% in (P<0.001), respectively, with severe PI occurring in 2.6% and 46.3% of the recipients (P<0.001). The median time from PI diagnosis to transplant was 230 days (29-1080 days) and 4 days (2-104 days) (P<0.001), the case-fatality rate for PI was 6.7% and 17.4% (P=NS), and the mortality rate was 0.5% and 9.8% (P<0.001) in Ktx and Ltx recipients, respectively; Gram-negative organisms were the most common in both Ktx and Ltx recipients, but Ltx recipients had significantly higher incidence of multidrug-resistant bacteria (12.9% vs 37.0%, P=0.005)., Conclusion: The knowledge of PI after the transplantation will benefit appropriate prophylactic and empirical treatment to improve the survival of Ktx and Ltx recipients.

Objective: To summarize the experiences in high-risk renal transplant recipients for ketter long-term survival., Methods: From April 1991 to December 2008, a total of 921 kidney recipients with high-risk factors were divided into six groups as following: (1) pediatric patients (< 18 years old) (GI, n = 34); (2) retransplant recipients (GII, n = 169); (3) high sensitized patients (PRA> 30% or peak PRA > 50%)(GIII, n = 35); (4) elderly recipients (> 60 years old) (GIV, n = 297); (5) diabetic patients (GV, n = 112); (6) patients with HBV/HCV infection or HBV/HCV carrier (GVI, n = 274). Each group was compared to a control of 807 recipients without any above risk factor for patient and graft survival at 1, 3 and 5 years. Incidences of acute rejection (AR), chronic rejection (CR) and complication were analyzed and compared respectively between the studied subjects and the control group as well., Results: Compared with the control group, patient/graft survivals were lower in GII, GIII and GVI (all P < 0.05), GIV had worse patient survival (P < 0.05); AR and CR incidences were greater in GI and GIII (all P < 0.05); GIV, GV and GVI had more complications., Conclusions: This study suggests the benefits for long-term outcome in high-immunological risk renal transplant recipients of low acute selection incidence rate, and reduction of complication incidences is the key to long term results for non-immunological high risk recipients.

Objective: To explore the effect of KIR/HLA ligand matching which mediates activated or inhibitory signal pathways on acute rejection (AR) after kidney transplantation., Methods: HLA and KIR genotype assortments were analyzed in 53 donor/recipient pairs of kidney transplantation. The recipients were divided into AR group (GI, n=19) and stable renal function group (GII, n=34) based on the early graft function. The impact of donor HLA, recipient KIR and distinct KIR/HLA class I ligand combinations on acute rejection after kidney transplantation was studied., Results: No significant differences were found in donor HLA-C1/2, HLA-A3, HLA-A11, or HLA-Bw4 between GI and GII groups. The frequency for KIR2DL2/2DS2 and KIR genotype assortment (AA) of the recipients in GI group were significantly lower than that in GII group (26.3% vs 55.9%, P=0.038; 31.6% vs 67.6%, P=0.011). The incidence of AR was significantly lower in donor HLA-C1/1 than in non-C1/1 (31.6% vs 46.7%, P>0.05), and lower in recipient KIR genotype assortment (AA) than in non-AA (20.7% vs 52.2%, P=0.011). A significant higher number of matches for the KIR2DL2/ HLA-C1 and KIR2DL3/HLA-C1 were observed in GII group (P=0.030, P=0.028)., Conclusion: Distinct KIR/HLA class I ligand combinations between the donor and recipient (such as KIR2DL2/ HLA-C1 and KIR2DL3/HLA-C1) may reduce the incidence of AR. A good KIR/HLA class I ligand matching will benefit the survival of the renal allograft.

Objective: To review the clinical experiences concerning simultaneous liver-kidney transplantation in polycystic kidney and hepatic disease with kidney and liver failure., Methods: This study involved 8 cases of simultaneous liver-kidney transplantation in polycystic kidney and hepatic disease with kidney and liver failure. There were 5 male and 3 female patients, aged from 41 to 67 years old with a mean of 52.8 years old. Six cases transplanted kidney after liver with orthotopic liver transplantation, and 2 cases transplanted liver after kidney with piggy-back liver transplantation. The acute rejections, complications, liver function, kidney functions, and survival rates of patient/liver/kidney were recorded., Results: Within the follow-up of 28 to 65 months, all 8 patients are still alive with normal liver and kidney functions: 2 living more than 5 years, 2 living more than 4 years and 4 living more than 2 years. 2 cases of pleural effusion and 1 case of pneumonia were complications after operation, which had been cured successfully. No acute rejection of allograft was observed., Conclusions: Simultaneous liver-kidney transplantation is a safe and effective treatment for polycystic kidney and hepatic disease with kidney and liver failure.

Objective: To investigate the types, clinical features and therapeutic approaches of congenital anomalies of the vagina., Methods: The clinical data of 81 patients with congenital anomalies of the vagina were analyzed retrospectively., Results: There were 5 types in these 81 patients, and 16 (19.7%) patients showed absence of the vagina, 15(18.5%) had vaginal obstruction, 10 (12.3%) had transverse vaginal septum,14(17.2%) had longitudinal vaginal septae,18(22.2%) had septum obliquus, and 8 (9.8%) had imperforate hymen. Forty-eight (59.2%) patients presented with primary amenorrhea, and 22(27.1%) complained of irregular pelvic pain. Fifteen of the patients with absent vagina underwent amnion artificial vaginoplasty, and the others were treated with incising and removing the septum, all having good clinical outcomes., Conclusion: Amnion artificial vaginoplasty is a good option for treatment of absent vagina.

Objective: Some research has shown that resveratrol can ameliorate myocardial injury and improve cardiac function in mice with acute viral myocarditis (VMC), and can inhibit cardiac fibroblast proliferation and myofibroblast differentiation in vitro. This study was designed to investigate whether resveratrol has similar effects in the mouse model of chronic VMC., Methods: One hundred mice were inoculated with 0.3 mL of Coxsackievirus B3 1*106 TCID50. Thirty days later, the survivors (n=62) were used as a model of chronic VMC, and were randomly assigned to 4 groups: untreated VMC, and low- (10 mg/kg), middle- (100 mg/kg) and high-dose (1 000 mg/kg) resveratrol-treated VMC (once daily, for 30 days). Ten mice which received neither Coxsackievirus B3 nor resveratrol treatment served as the control group. After 30 days of resveratrol treatment, the mice were sacrificed. Serum concentrations of collagenous pre-peptides (PINP, PICP and PIIINP) were assessed using ELISA. Hematoxylin-eosin staining, picrosirius red staining and circularly polarized light were used to examine the histochemistry of myocardial collagen., Results: The myocardial collagen volume fraction in the high-dose (0.74+/-0.19) and the middle-dose (1.07+/-0.12) resveratrol-treated VMC groups was significantly lower than that in the untreated VMC (2.33+/-0.18) and the low-dose resveratrol-treated VMC (2.17+/-0.19) groups (P<0.05). Compared with the untreated VMC group, serum concentrations of PICP and PIIINP in the high-dose and the middle-dose resveratrol-treated VMC groups were significantly reduced (P<0.05), while PINP concentrations increased significantly (P<0.05)., Conclusions: Resveratrol can inhibit hyperplasia of myocardial collagen in the mouse model of chronic VMC, acting as an effective anti-fibrotic agent in the myocardium.

Objective: To study the changes in Notch1 expression on peripheral lymphocytes after acute graft rejection after renal transplantation., Methods: Twenty renal transplant recipients experiencing acute graft rejection and 20 without acute rejection were enrolled in this study. Flow cytometry was used to detect the expression of Notch1 on peripheral lymphocytes of the patients before operation, at the occurrence of acute rejection and after anti-rejection therapy. The rates of Notch1-positive lymphocytes measured at different time points were compared between the two groups., Result: In patients with acute graft rejection, Notch1 expression at the time of rejection onset was significantly higher than that before operation (t=4.245, P=0.000) and that of patients with graft rejection (t=3.839, P=0.000), and was obviously decreased after anti-rejection therapy (t=3.102, P=0.004). Patients without graft rejection showed no significant changes in Notch1 expression after the transplantation (P=0.409). Notch1 expression was comparable between the recipients receiving Tac therapy and those with CsA therapy (P>0.05)., Conclusion: Monitoring Notch1 expression on the peripheral lymphocytes after renal transplantation may help in the diagnosis of acute graft rejection and prediction of the effect of an anti-rejection therapy.

Objective: To investigate the genotypes of natural killer cell immunoglobulin-like receptor (KIR) genes and their frequencies in Chinese subjects and explore the mechanism of the actions of nature killer cells., Methods: The DNA samples were obtained from 67 randomly selected unrelated Chinese Han individuals for genotyping of the KIR genes using PCR with sequence-specific primers (PCR-SSP), and the frequencies of the KIR genes in these Chinese subjects were compared with the reported frequencies in populations of other nationalities., Results: Sixteen KIR genes were identified in these Chinese subjects, and 87.5% of these genes were expressed at frequencies above 0.35. Fourteen functional KIR genes combined into 25 KIR genotypes, among which the most frequent genotype KIR-2DL1-2DL3-2DL4-3DL1-3DL2-3DL3-2DS4 showed a frequency of 0.373, while the frequencies of all the other genotypes were no greater than 0.09. Comparison of the KIR combinations in Chinese Han population with those of Japanese, Korean, and Caucasians populations identified 8.93% of the KIR combinations shared by all these populations; the Chinese, Koreans and Caucasians shared 5.36% common KIR combinations, whereas only 1.79% common combinations were found in Chinese and Caucasians. In this study, 16 new gene combinations were identified (25.28%)., Conclusion: This study shows the high-frequency distribution of a single KIR gene polymorphism. The KIR combination KIR-2DL1-2DL3-2DL4-3DL1-3DL2-3DL3-2DS4 has the highest frequency in Chinese, Japanese, Korean and Caucasian populations, indicating that inhibitory signal transduction pathway plays an important role in the function of the natural killer cells. This study provide clues for new approaches for improving the prognosis of kidney transplantation by enhancing or inhibiting the function of the natural killer cells instead of life-time usage of immunosuppressive agents.

Objective: To identify the factors responsible for the inter-individual variations in the dosage/concentration of tacrolimus in renal transplant recipients., Methods: This study involved renal transplant recipients receiving immunosuppressive therapy with the tacrolimus, mycophenolate and prednisone regimen after the operation. The gender, age, height, body weight, tacrolimus dosage, hormone dosage, diarrhea, blood lipids, liver function, renal function, albumin, and hematocrit of the patients were recorded at different time points, namely in early stage (3, 7, 14, and 30 days postoperatively, 118 cases), at 3 months (103 cases), 6 months (75 cases) and over one year (119 cases) after the operation. The concentrations of tacrolimus and gene polymorphisms at CYP3A5, MDR1 3435, MDR1 2677 and MDR1 1236 were also determined in these patients. Multiple linear regression was used for analysis of these factors with tacrolimus concentration/dosage*body surface area as the independent variable., Results: Patients in early stage following renal transplantation showed rather poor fitting of the stepwise regression model, which increased obviously 3 months after the operation and further increased till reaching a stable level at 6 months. Multiple factors were found to affect tacrolimus concentration/dosage in the early postoperative stage, during which period these factors underwent drastic variations and became stable 3 months later. In terms of pharmacogenomics, the major factors affecting tacrolimus concentration/dosage included MDR1 3435, MDR1 2677 and MDR1 1236 polymorphisms, which vastly varied between the patients early after the operation. Of these polymorphic sites, CYP3A5 produced only minor effects on tacrolimus concentration/dosage, and was not included as an active factor until the stable phase (over 1 year) following the transplantation; MDR1 3435 was found to be the predominant factor affecting tacrolimus metabolism in the stable phase. Age, liver function, albumin and hematocrit were found to be positively correlated to the independent variable tacrolimus concentration/dosage*body surface area, and identified as important factors responsible for the intra-individual variation of tacrolimus dosage/concentration., Conclusion: The variations in the factors affecting tacrolimus dosage/concentration after renal transplantation are consistent with the clinical features of the patients, and these factors vary with the postoperative stages. Pharmacogenomic factors produce the most conspicuous effect on tacrolimus dosage/concentration, and agents that may interfere with tacrolimus metabolism should be avoided after the operation. Age, liver function, albumin and hematocrit are also important factors responsible for the variation of tacrolimus dosage/concentration.

Objective: To research the techniques and correlated issues during analogous procedure of human intro-utero fetal cardiac intervention in animal model, so as to impulse the clinical utilizing of cardiac intervention in human fetus with severe cardiovascular malformations., Methods: Eight bigeminal pregnant ewes in latter 2nd-trimester and 3rd- trimester were taken into the research of fetal cardiac intervention. Under continuous ultrasound guidance, advanced an cannula and stylet needle through the maternal abdomen, uterine wall, and fetal lamb chest wall and into the fetal LV, then imitate human balloon aortic valvuloplasty at valve ring level. Probed into aspects of animal preparation, position of fetal lambs, paracentesis point selecting, main points of intervention, ultrasound utilizing, fetal lambs incubation and protection to placenta as well as umbilical cord., Results: Eight pregnant ewes were all survival after procedure, 2 was executed after fetus' death, the other 6 continued gestation until spontaneous vaginal delivery after an uneventful pregnancy. After parturition the 6 ewes were in good condition. There were no nick infection, chorioamnionitis and other complications. Eight/sixteen fetal lambs were undergone intro-utero cardiac intervention. The values of body weight and Hct of lambs which were executed, pre-term and full-term delived were (1.77 +/- 0.14) kg vs. (2.15 +/- 0.23) kg vs. (2.41 +/- 0.19) kg and 29%o-33% vs. 27%-35% vs. 37%-41%. In autopsy, hydropericardium was found in 4/8 with 1-2.5 mL and 1/8 with 5 mL. Besides 1/8 with interventricular septum centesis injury, there was no centesis damage to endocardium, valve, chordae tendineae, papillary muscles and sortic tunics intima. Whereas there was no centesis injury to lung, liver and chylostomach, no trace of ericardium and thoracic infection., Conclusions: Animal model of intra-utero fetal cardiac intervention was setted up successfully, the experiences in this study was worth to be payed attention to in human fetal cardiac intervention.

Objective: To study the value of detection of both preoperative soluble CD30 (sCD30) and hepatocyte growth factor (HGF) level 5 days after transplantation in the diagnosis of acute rejection of renal allograft., Methods: Preoperative serum sCD30 levels and HGF level 5 days after transplantation were determined in 65 renal-transplant recipients using enzyme-linked immunosorbent assay. The recipients were divided according to the sCD30 levels positivity. Receiver operating characteristic (ROC) curves were used to assess the value of HGF level on day 5 posttransplantation for diagnosis of acute renal allograft rejection, and the value of combined assay of the sCD30 and HGF levels was also estimated., Results: After transplantation, 26 recipients developed graft rejection and 39 had uneventful recovery without rejection. With the cut-off value of sCD30 of 120 U/ml, the positivity rate of sCD30 was significantly higher in recipients with graft rejection than in those without (61.5% vs 17.9%, P<0.05). Recipients with acute rejection showed also significantly higher HGF levels on day 5 posttransplantation than those without rejection (P<0.05). ROC curve analysis indicated that HGF levels on day 5 posttransplantation was a good marker for diagnosis of acute renal allograft rejection, and at the cut-off value of 90 ug/L, the diagnostic sensitivity was 84.6% and specificity 76.9%. Evaluation of both the sCD30 and HGF levels significantly enhanced the diagnostic accuracy of acute graft rejection., Conclusion: Combined assay of serum sCD30 and HGF levels offers a useful means for diagnosis of acute renal allograft rejection.

Objective: To compare the long-term effect and safety of tacrolimus (FK506) and cyclosporine (CsA) in kidney transplant (KT) recipients carrying hepatitis B Virus(HBV)., Methods: A total of 109 patients with HBV were randomized into FK506 group (52 cases) and CsA group (57 cases) after KT, and a 2-year-long follow-up of the patients was conducted to record the patient and graft survival, incidence of acute graft rejection and postoperative liver function., Results: The 2-year patient/graft survival was 86.0%/73.7% and 94.2%/90.3% in CsA and FK506 groups, respectively (P<0.05), with incidence of acute rejection of 10.5% and 9.6% (P>0.05), and rate of abnormal liver function of 26.3% and 15.4% (P<0.05), respectively. Eight patients (14.4%) in CsA group required a drug conversion but none in FK506 group. The drug conversion resulted in significant reduction of ALT/AST level from 255.13+/-31.38/201.88+/-21.25 U/L to 31.25+/-11.50/25.13+/-9.68 U/L (P<0.01)., Conclusion: For HBV-carrying renal transplant recipients, FK506 as the primary choice of immunosuppressant can be more effective and safer than CsA.

Objective: To discuss adequate application of mycophenolate mofetil (MMF) in hepatitis C patients after kidney transplantation., Method: A one-year follow-up study was conducted in 49 patients with hepatitis C but normal liver function before kidney transplantation, who were given postoperatively immunosuppressants of predisone, MMF and CsA/FK506. Patients with abnormal liver function after kidney transplantation who continued MMF therapy at routine dose and those with reduced or suspended MMF therapy all received intravenous therapy for liver protection, and the duration of therapies was recorded., Results: Nineteen patients presented with abnormal liver function after operation, and the duration of abnormal liver function till recovery was 32.82-/+4.13 days in the patients with unsuspended MMF therapy and 13.31-/+2.98 days in those with reduced or suspended MMF (P<0.05); the former patients required subsequently 62.7-/+3.23 days to recover normal liver function and the latter need only 23.4-/+2.29 days (P<0.05)., Conclusion: MMF should be reduced or suspended when liver function abnormality occurred in patients with hepatitis C after kidney transplantation, and immediate intravenous therapy for liver protection may prove beneficial.

Objectives: To explore applicable protocol for the positioning of ventricular septal defect (VSD) occluder and the selection of the device by retrospective analysis of transcatheter closure approach to the aneurysms of the perimembranous VSD., Methods: Thirty-five cases of perimembranous VSD with septal aneurysm (19 males and 16 females) from May, 2004 to May, 2005 were included, with a mean age of 5.3 y and mean weight of 17.6 kg. Their angiographic and ultrasound data, and interventional processes were analyzed. Seven segments of the aneurysms were assessed: the diameter of the defect on the left ventricle, the diameter of the defect on the right ventricle, the thickness of ventricular septum, the distance from the farthest end of the aneurysm to the defect, the diameter of the widest part of the aneurysm and the distance between the two farthest orifices on the aneurysm., Results: Sixteen cystiform aneurysms and nineteen tubiform ones were identified with left ventricular angiography. The diameters of the orifices of aneurysms and the diameters of the VSDs ranged from 1.5 mm to 4.1 mm and 2.7 mm to 11.9 mm, separately, with the mean of 2.9 mm and 4.3 mm. From the echocardiography, the distances of the rim of defect to the aortic valve ranged from 2.0 mm to 7.0 mm, with the mean of 4.3 mm. All the interventions were successfully done with symmetrical devices from 4 mm to 14 mm. The left disc of the device was positioned at the defect surface from the left ventricle in 29 cases, and was released at the left side of the orifice in 3 cases., Conclusions: The positioning of the left disc is mostly determined by the condition for the correct formation of the right disc in the right ventricle after deploying. Generally the defect surface in the left ventricle is most ideal to release the left disc of the device. If the body of aneurysm was too long for the right disc to restore its configuration, the left disc should be released on the left side of the orifice. The selection of device size is determined by the placement of the left disc. When the left disc is to be released at the defect surface in the left ventricle, the device size should be equal to or 1 to 2 mm larger than the diameter of the defect on the left ventricle. When the left disc is to be deployed on the left side of an orifice, the device size should be equal to or 1 mm larger than the defect diameter on the left ventricle when there is a single orifice. In the case of multiple orifices, the minimal size of the device which can cover all the orifices should be selected.

Objective: To summarize the treatment experience of long-term surviving patients after combined abdominal organ transplantation., Methods: From October 2001 to January 2005, 19 patients received combined abdominal organ transplantation in Nanfang Hospital, including 6 with simultaneous kidney-pancreas transplantation (SKPT), 12 with combined liver-kidney transplantation (CLKT), and 1 with simultaneous liver-pancreas transplantation (SLPT). The periods of follow up were from 6 months to 3 years and 8 months. Summarize primary diseases of the patients, factors which impacted on patients long-term survival rate, and immunological characteristics of combined abdominal organ transplantation., Results: All of 19 transplant cases were performed successfully. Among then, 18 were followed up; 16 survived till now; 2 patients undergoing liver-kidney transplantation were dead, one of which died from myocardial infarction in the 18 months after operation, and one died from cytomegalovirus in infection of lung in 13 months; 1 liver-kidney transplantation patient and 2 pancreas-liver transplantation patients experienced acute rejection once; 2 patients were found nephrotoxicity. Among the 18 patients, 4 patients' survival time were over 3 years, 7 over 2 years, 6 over 1 year, 1 over 10 months., Conclusions: Combined abdominal organ transplantation is effective for treatment of two abdominal organ failure diseases. Factors which impact on patients long-term surviving include choosing suitable recipient, high quality of donated organ, avoidance of surgical complication, the history of myocardial infarction before operation, immunosuppressive regime and virus infection late after transplantation. Combined abdominal organ transplantation has some different immunological characteristics from single organ transplantation.

Objective: To investigate the effect of treatment on end-stage liver disease and type-I diabetes mellitus with simultaneous liver-pancreas-duodenum transplantation., Method: In September 2003, one patient with chronic hepatitis B, liver cirrhosis, hepatic cellular cancer, and insulin-dependent diabetes received simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation. Liver and pancreas graft function was monitored after transplantation., Results: The function of pancreas allograft was recovered immediately and the patient became insulin-independence postoperatively. The liver allograft was experienced an acute rejection episode and reversed by intravenous bolus methylprednisolone. The recipient was currently liver disease-free and insulin-free more than 21 months., Conclusions: The simultaneous liver-pancreas-duodenum transplantation is an effective method in the treatment of end-stage liver disease and type-I diabetes mellitus.

Objective: To analyze the T cell receptor (TCR) Vbeta gene usage of the cytolytic T-lymphocytes which result in immune-mediated myocyte injury in Coxsackievirus B3-induced myocarditis., Methods: An experimental murine model with a myocarditic variant of Coxsackievirus B, type 3 has been developed with newborn Balb/c male mice. Mice were killed on day 7 after virus inoculated, which was the time when T cells show significant differentiation. With immunoadsorption, ACTLs, VCTLs, MCTLs are respectively isolated from mesenteric lymph nodes of Balb/c mice suffered from viral myocarditis. T-lymphocytes prepared from mesenteric lymph nodes of uninfected Balb/c mice served as control group. RT-PCR was performed with standard method. The Vbeta gene usage was analyzed by running the electophoresis of PCR products on agarose gel., Results: T cells of control group expressed all Vbeta genes of 20 families. But the TCR VP gene usage of CTLs in experimental groups was markedly restricted. ACTL expressed predominantly Vbeta6, Vbeta8.1, Vbeta8.2, Vbeta8.3, MCTL expressed predominantly Vbeta5.1, Vbeta8.1, Vbeta8.2, Vbeta8.3 and VCTL expressed predominantly Vbeta7, Vbeta8.1, Vbeta8.2, Vbeta8.3., Conclusions: The TCR Vbeta gene usage of CTLs which result in immune-mediated myocyte injury in Coxsackievirus B3-induced myocarditis is markedly restricted in cells stimulated by specific antigen.

Objective: To investigate the expressions of transforming growth factor (TGF)-beta1 and collagen IV in the renal tissues of patients with chronic allograft nephropathy (CAN)., Methods: Immunohistochemical method and computer-assisted image analysis system were used to detect the expressions of TGF-beta1 and collagen IV in the renal tissues of patients with CAN, and the association between TGF-beta1 and collagen IV expressions as well as that between their expressions and the pathological grading of CAN were analyzed., Results: The expressions of TGF-beta1 and collagen IV were significantly higher in the renal tissues of the patients than in normal renal tissues (P<0.001), and the expressions tended to increase with the pathological grades of CAN; TGF-beta1 and collagen IV expressions in both the renal glomeruli and the tubulointerstitium were in patients with CAN positively correlated with normal renal tissues (r=0.943, P<0.001; r=0.910, P<0.001)., Conclusions: Abnormal collagen IV deposition is one of the major factors associated with renal fibrosis in CAN, and TGF-beta1 might play an important role in renal fibrosis in CAN through up-regulation of collagen IV in the renal tissues.

Objective: To summarize the experience with perioperative management of multiorgan transplantation., Methods: From October 2001 to January 2005, 19 patients received multiorgan transplantation in Nanfang Hospital, including 6 with simultaneous kidney-pancreas transplantation (SKPT), 12 with combined liver-kidney transplantation (CLKT), and 1 with simultaneous liver-pancreas transplantation (SLPT). The surgical techniques, application of immunosuppressants, and complication management were reviewed., Results: All transplantation procedures were performed successfully. The transplantation-related complications included tacrolimus-induced renal toxicosis in 1 (5.3%) case, acute graft rejection in 3 (15.8%) cases, intestinal hemorrhage in 2 (10.5%) cases, intra-abdominal hemorrhage in 1 (5.3%) case, and lung infection in 1 (5.3%) case, all of which were cured after proper treatment., Conclusions: Donor selection, good quality of the donor organ, proper surgical approaches, adequate use of the-mmunosuppressants, and prevention of complications are essential to the success of multiorgan transplantation.

Objective: To investigate the relationship of the renal allograft weight and the recipient's body weight with allograft function after transplantation., Methods: The correlation of the renal allograft weight, the recipient's body weight, the ratio of the allograft weight to the recipient body weight and the mean serum creatinine (sCr) 3 years after transplantation were measured in 108 kidney recipients., Results: The allograft weight was inversely correlated with the mean sCr 3 years after transplantation (P<0.01)., Conclusion: The renal allograft weight, recipient's body weight and the ratio of allograft weight to recipient's body weight are important indicators of the long-term allograft function after transplantation, and recipients with greater body weight should receive allografts of higher weight.

Objective: To study the influence of hepatitis C virus (HCV) infection on the clinical outcome of kidney transplantation., Methods: The recipient/graft survival, the incidence of acute/chronic rejection and cause of death in 86 HCV-infected recipients of renal transplantation were compared with those in another 86 recipients without HCV infection., Results: HCV-infected recipients had significantly shorter 5-year survival (74.4%) than those without HCV infection (87.2%, P<0.01). The 1-year (94.2%/90.7% vs 96.8%/96.0%) and 3-year recipient/graft survival rates (88.4%/79.1% vs 90.7%/87.2%), the incidence of acute/chronic rejection (31.3% vs 21.2%, and 12.5% vs 6.5%) and the 5-year graft survival (73.3%/81.4%) were comparable between the two groups (P>0.05). Hepatic disease was identified as the primary cause of mortality., Conclusions: HCV infection may affect the long-term survival of the recipients with kidney transplantation, and therefore should be considered as a relative contraindication of kidney transplantation.

Objective: To study the effect of combined transplantation of the liver and the pancreas in diabetic patients with end-stage liver disease, and explore the optimal surgical procedure., Methods: Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations were performed in a patient diagnosed as having chronic hepatitis B, hepatocirrhosis, hepatic cellular cancer, and insulin-dependent diabetes. Immunosuppression therapy utilized prednisone, tacrolimus (FK506), mycophenolate mofetil (MMF), and simulect. The function of the liver graft, serum amylase and lipase, blood glucose, and C-peptide were monitored after transplantation., Results: Insulin was withdrawn at the 6th day after operation, good liver allograft functional recovery was achieved, without such complications as pancreatitis, thrombosis, and localized infections., Conclusion: End-stage liver disease with concomitant insulin-dependent diabetes is the indication for combined liver-pancreas transplantations, for which simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations may constitute the optimal surgical approaches as the primary choice.

Objective: To compare the efficacy and safety of tacrolimus (FK506)- versus cyclosporine (CsA)-based immunosuppression protocol in the treatment of patients with renal transplantation for diabetic end-stage renal disease., Methods: A total of 64 patients with end-stage renal disease were randomized into FK506 (n=33) and CsA (n=31) group after cadaveric renal transplantation, the former group adopting small-dose FK506 therapy with low trough concentration, and the latter receiving CsA therapy. The dose of insulin was adjusted according to blood glucose level of the patients after the operation. The incidence of acute rejections, blood glucose level, the dose of insulin and changes in blood pressure, lipid metabolism and liver function were compared between the two groups., Results: The 1-year patient/graft survival rates were 96.97%/93.94% in FK506 group and 96.77%/90.32% in CsA group. Four patients (12.12%) developed acute rejection in the FK506 group, while 11 (35.48%) did in the CsA group during the first year after the operation (P<0.05). The dose of the insulin of the FK506 group (34.35 U/d, 14.09 U/d) was not significantly different from that in the CsA group (28.15 U/d, 13.05 U/d) at the first month and 1 year after the operation (P>0.05). One year after the operation, 21 patients (63.63%) required anti-hypertension treatment, 5 (15.15%) needed anti-hyperlipidemia treatment and 3 (9.09%) had abnormal liver function in FK506 group, while in the CsA group, 28 patients (90.32%) needed anti-hypertension therapy, 13 (41.94%) received anti-hyperlipidemia treatment and 11 (35.48%) showed signs of abnormal liver function, with significant differences between the two groups., Conclusions: Small-dose FK506 therapy with low concentrations is effective in the postoperative management of patients with renal transplantation for diabetic end-stage renal disease, with only mild adverse effect. FK506 is comparable with CsA in terms of the effect on glucose metabolism of the patients.

Objective: To study the surgical techniques, perioperative management, management of infections and graft rejection in patients with combined liver-kidney transplantation (CLKT)., Methods: CLKT was performed in a 66-year-old patient with alcoholic liver cirrhosis and uremia. Lavage in situ with University of Wisconsin (UW) solution of the donor organs and en hoc resection was performed. Orthotopic liver transplantation (OLT) and routine kidney transplantation were respectively carried out. Immunosuppression therapy consisted of tacrolimus (FK506), antithymocyte globulin (ATG), mycophenolate mofetil (CellCept, MMF) and corticosteroid., Results: Both of the transplanted organs rapidly recovered normal functions after operation, and acute rejection of the liver graft occurred on day 10 after operation but was controlled after methylprednisolone pulse therapy. The patient fully recovered and was discharged from hospital on day 29 after operation., Conclusions: CLKT is effective against both liver and renal function failure. Well-matched HLA tissue typing, proficient surgical skills, adequate application of immunosuppressants and effective management of postoperative complications are crucial for successful CLKT.

Objective: To establish rabbit model of renal allograft transplantation with reduced complications and high survival rate using microsurgical technique., Methods: Twelve healthy adult rabbits were randomly divided into 2 groups of equal number, one as donor group and the other recipient. The left kidneys of the donor rabbits were removed followed by immediate reperfusion with 4 degrees celsius H-CA solution, before they were transplanted into the recipient rabbits with their left kidneys excised and end-to-end anastomosis of the renal arteries, veins and ureter respectively performed with microsurgical technique. Another 12 normal rabbits received operations to temporarily block the right renal arteries and veins, serving as control group, in which 11 completed the experiment., Results: No thrombosis or stricture occurred at the site of anastomosis in rabbits with renal allograft transplantation, and the survival rate reached 91.7% (11/12)., Conclusion: This rabbit model of renal allograft transplantation has markedly fewer complications with improved survival rate, thus providing a more practical and reliable model for experimental and clinical studies of renal transplantation.