Objective To assess the efficacy and safety of direct-acting antiviral ( DAA) therapy for hepatitis C after renal transplantation. Methods By a retrospective analysis, we recruited seven patients who were infected with hepatitis C virus ( HCV RNA) and treated with direct-acting antiviral agents therapy after kidney transplantation in our transplantation department. Serum HCV RNA, alanine transaminase ( ALT), estimate glomerular filtration rate ( e GFR) and serum creatinine level were measured at baseline, 2nd, 4th, 12 thweek of treatment, and 12 th, 24th, 48 thweek after the treatment. Survival rate of these patients at 1 year post-therapy was analyzed. Results Seven kidney graft recipients infected with HCV were enrolled in our study. All these patients were given DAA therapy for 12 weeks. At the end of therapy, HCV RNA was negative in all patients. The serological test had a rapid virologic response ( RVR) of 100％ ( 7/7), SVR12, SVR24 were 100％, and ALT at 2thweek of treatment had improvement compared with that before treatment. ALT levels remained stable thereafter; e GFR and blood muscle levels remained stable throughout the study period. Conclusion During the 1 year follow-up period, the therapy for patients infected with hepatitis C virus after kidney transplantation is safe and effective, and kidney function after transplantation was relatively stable during the research period.

邺城自春秋齐桓公筑城以来，历经战国、秦汉、三国魏晋、南北朝时期的北齐、直到毁于大象二年（580年），先是作为侯都，进而成为王都，最后成为帝都。东汉末年曹魏政权在邺建立，此时"建安文学"应运而生。邺城的繁华造就了文学的成就，具有代表性的“三曹”、“七子”就是在此形成的。

Objective To investigate the pharmacokinetic (PK) characteristics of enteric-coated mycophenolate sodium (EC-MPS) and area under the curve (AUC) from 0 to 12 h by limited sampling strategies (LSSs) in de novo kidney transplant patients of Chinese ethnicity.Method The PK data from 20 Chinese renal transplant recipients collected during the maintenance period after transplantation were analyzed retrospectively.Ten blood samples were obtained after EC-MPS was given on the postoperative day 21.Blood concentrations of mycophenolic acid were measured and AUC was estimated using high performance liquid chromatography in recipients receiving immunosuppressant EC-MPS plus tacrolimus and steroid.LSSs with jackknife technique,multiple stepwise regression analysis,and Origin 7.5 analysis were developed to estimate mycophenolic acid (MPA) AUC.Result There was wide inter-individual variation in MPA plasma level and the AUC.The best equations obtained in the test group were for 3 and 4 time points:AUC0-12h (mg· h· L-1) =12.820 + 0.662 × C1.5h + 1.750 × C4h + 4.213 × C8h,and AUC0-2h (mg· h· L-1) =12.119 + 0.676 × C1.5h + 1.685 × C4h + 1.429 × C6h + 2.573 × C8h respectively.When these LSSs were.tested in the validation group,the results were acceptable (R =0.861,P＜0.001 for 3 time points,and R =0.882,P＜0.001 for 4 time points).Conclusion LSSs are useful for MPA AUC0-12h estimation in Chinese renal transplantation patients.LSSs using time points at C1.5h-C4h-C8h or C1.5h-C4h-C6h-C8h provide the most reliable and accurate estimation of the AUC0-12h of mycophenolic acid in Chinese stable renal transplant recipients receiving EC-MPS and tacrolimus.

Objective To evaluate the safety and validity of an early steroid withdrawal protocol including cyclosporine (CsA) and mycophenolate mofetil (MMF) in middle aged and elderly renal transplant patients. Methods Between September 2000 and April 2008, the prospective, randomized study design was used in 80 middle aged and elderly renal transplant patients. Steroid withdrawal group (n=39) with primary cadaveric kidney transplants received a protocol consisting of CsA 4～6 mg·kg~(-1)·d~(-1) beginning at postoperative day 3, MMF 0. 75 g twice a day from the next postoperative day, and methylprednisolone (MP) 500 mg daily from day 0 to 3. Then prednisone (Pred) 20 mg daily was gradually tapered and withdrawn after postoperative day 30. Conventional steroid treatment group (control group, n=41) received a regimen consisting of CsA, MMF and MP, and Pred 20 mg daily. Pred was tapered to 5 mg daily over a period of 6 months, then maintained thereafter. Outcome parameters were patient and graft survival rates, renal function, acute rejection ( AR), arterial hypertension, hyperlipidemia or diabetes mellitus, weight gain and infection. Results The incidence of AR in the steroid withdrawal group was similar to the control group (23. 1% vs. 19. 5%, χ~2=0. 15,P>0. 05). Patient survival rates at 12, 24, 36 months were 97. 4%, 94. 8% and 88.0% in the steroid withdrawal group and were 97.6%, 97.6 and 87.8% in the control group, respectively (χ~2=0. 17, P>0. 05). And graft survival rates were 94. 9%, 88. 6% and 83. 7% in the steroid withdrawal group and were 95. 1%, 91. 5% and 79. 5% in control group, respectively (χ~2 = 0.07, P>0. 05). Conclusions In middle aged and elderly renal transplant patients, early steroid withdrawal is feasible and may not significantly increase the risk of acute rejection episodes.

Objective: To explore the effect of folic acid,Vit B6,and Vit B12 on hyperhomocysteinemia in renal-transplant recipients.Methods: 195 renal-transplant recipients were randomly divided into the vitamin treatment group(group A,n=103,folic acid 5 mg/d,vitamin B6 50 mg/d,Bl2 1 mg/d,totally 2 months) and the control group(group B,n=92).The plasma Hcy levels were determined before treatment,before operation and 1,10,20 and 30 days after operation.Results: The plasma level of Hcy in group B was significantly higher than that in group A before and after operation.The rate of acute rejection was lower in group A than in group B.Conclusion: Vitamin B supplementation can reduce the homocysteine level and the rate of acute rejection for renal-transplant recipients.

Objective To investigate the expression and the clinical significance of survivin proteins in tissues of renal cell carcinoma (RCC). Methods Expression of survivin proteins were detected by immunohistochemical technique in tissues of 52 cases of renal cell carcinoma and 10 cases of normal kidney. Results Survivin was undetectable in all normal renal tissue, while it was expressed in 92.31% (48/52) of the RCC. In RCC, there was significant correlation between the expression of survivin and lymph node status, but no association between the expression and some clinical characters, including patient age, sex, tumor size and carcinomatous embolus status in inferior vena cava. There was significant relation between the expression of survivin and the pathologic features(P<0.05). No significant difference was observed between the expression of survivin and the clinical stage in RCC. The type of pathology of RCC was not correlated with the expression of survivin. Conclusion These results suggest that the expression of survivin may be upregulated during the development of human renal cell carcinoma. Therefore, survivin might be a useful criterion to propose the diagnosis of RCC.

目的研究M受体亚型在正常成人前列腺各区带中的分布特征,分析不同亚型在不同区带中的基因与蛋白表达差异。方法取7例意外死亡健康成人新鲜尸体前列腺标本,免疫组织化学染色方法测定M受体亚型(M1～M3)在前列腺各区带中的分布密度,荧光定量逆转录聚合酶链反应(RT-PCR)方法测定M受体各亚型(M1～M5)在前列腺各区带中的基因表达水平。结果各M受体亚型在正常成人前列腺各区带中均有分布;M1～M3受体主要分布在腺上皮周围,中央带M3的表达腺体区(0.356±0.134)高于间质区(0.137±0.090,P<0.0001);移行带及外周带M2在腺体的表达高于间质(P<0.01)。前列腺各区带中各受体表达存在差异,中央带、移行带及前纤维肌区M2表达均高于M4(P<0.05);各受体基因水平与蛋白水平表达存在差异,基因表达最高者为M2在前纤维肌区(0.0467±0.0516),蛋白表达最高者为M2在外周带(0.290±0.148)。结论M受体及其各种亚型在正常成人前列腺各区带中有着广泛分布,在前列腺各区带中各亚型的分布密度及基因表达水平均存在差异。

Objective: To study the distribution of cholinergic muscarinic receptor subtypes(M_1～M_3) in healthy adult human prostate.Methods: Immunohistochemistry and real-time reverse transcription polymerase chain reaction techniques were used to study the distribution of cholinergic muscarinic receptor subtypes in prostate of 17 healthy adult persons.Results: The three subtypes of muscarinic receptor were all presented mainly round the epithelium and rarely in stroma by the two methods;of them,M_2 held the highest density.Conclusion: All the three subtypes of cholinergic muscarinic receptor are presented in some rule in healthy adult human prostate gland,which may contribute to the action of prostate.

Objective: To investigate the causes for vesania in postrenal transplantation patients.Methods: We reviewed and analyzed the process of diagnosis and treatment of 9 patients caught vesania after kidney transplantation.They were all treated using sedatives,8 of them were transfused using Diazepam,the largest dosage was 90mg within 24 hours.However,5 of them still showed the symptom of vesania after transfusion,so they were injected with 25?mg Chlorpromazine and 25?mg Promethazine.Results: After being used sedative,the patients were calmed down gradually and then could be treated easily,5 of the patients were in the state of lethargy with stable vital signs.After 24 to 72 hours,patients were given less sedative till not according to their condition.Being stable,8 patients were discharged 28-72 days later.The transplanted kidney of one sufferer was broken due to anxious.After nephrectomy,he was given Diazepam,and the symptom disappeared 28 hours later.One year later,He accepted transplantation and no symptom of vesania reappeared.Conclusions: Vesania after kidney transplantation contributes to comprehensive causes.

Objective To compare the prophylactic efficacy of combination of ganciclovir and acy- clovir or acyclovir alone against cytomegalovirus pneumonia in renal transplant recipients.Methods A to- tal of 217 renal transplant recipient(124 men and 93 women;mean age,32 years;age range,16-72 years) were divided into 3 groups randomly.In 51 cases,acyclovir was taken orally at a dose of 400 mg,3/d,from the third d to 3 months after transplantation.In 74 cases,ganciclovir was administered at a dose of 250 mg/d intravenously from the 21st d to 27th d to replace Acyclovir.In 92 cases,no prophylaxis against eytomegalov- irus pneumonia was performed.All patients were followed 3 months after transplantation.Comparison of the incidence rates of cytomegalovirus pneumonia among the 3 groups was performed using Fisher's exact test. Results Cytomegalovirus pneumonia developed in 20 cases in the 3 groups,including 4 cases(5.4%) in combined use group,2 cases(3.9%)in acyclovir alone group,and 14 cases(15.2%)in control group. Significant difference existed between the 2 experimental and control groups(P＜0.05).However,no signifi- cant difference existed between the 2 experimental groups(P＞0.05).Of the 20 cases,17(85.0%)were cured,and 3 died of respiratory failure.Conclusions Ganciclovir and acyclovir have prophylactic effect a- gainst cytomegalovirus pneumonia in renal transplant recipients.These 2 medications are inexpensive,and the patients have good compliance.

Objective:To summarize the long-term surval rate of the recipients receiving renal retransplantation.Methods:The clinical data of 41 cases of renal retransplantation between January 1999 and December 2005 were analyzed retrospectively.Of them,18 underwent allograft nephrectomy(group 1) and 23 did not(group 2).The graft survival rate at 1,3,and 5 years,the factors contributiving to the mortality and factors affecting the graft survival were observed. Results:The 1-,3-,and 5-year graft survival rates were 85.4%,76.2%,and(65.8%,) respectively,and those in group A and B were 88.9% vs 82.6%(P >0.05);74.7% vs 77.1%(P>(0.05),) and 62.2% vs 68.5%(P>0.05),respectively.Acute rejection(AR) rates were not significantly different between groups A(33.3%) and B(30.4%)(P>0.05).Incidence of AR was higher in patients with positive PRA,however,antibody-inducing therapy could lower the incidence of AR.Conclusions:Graft nephrectomy before retransplantation can not lengthen the long-term survival,and high quality of HLA matching and antibody-inducing therapy may improve the long-term survival rate of graft.

对36例自发性移植肾破裂患者的治疗情况进行回顾性分析。22例采用手术治疗(14例于破裂口填塞明胶海绵或自体脂肪后缝合,8例切除移植肾),14例保守治疗。认为随着保守治疗经验的积累和治疗成功率的提高,应尽可能避免二次手术切除移植肾,以保守治疗为主。

在102例同种异体肾移植术中,将双J管远端缝置7号丝线,长约15cm(女)或25cm(男),近端经输尿管置入肾盂,远端置入膀胱。待患者排尿时随尿流排出线尾,牵拉缝线,拔出双J管。结果100例患者于术后2~4周尿出线尾,顺利拔出双J管,2例未尿出线尾,4周后经膀胱镜拔出双J管。表明在同种异体肾移植术中,于双J管末端缝线,待患者尿出线尾后拔出双J管的方法,既简便又安全。

Objective To investigate the effectiveness of Rh-negative patients receiving Rh-positive renal grafts.Methods Three Rh-positive kidneys were transplanted in 3 Rh-negative uremia patients respectively. The pre- and intraoperative conditions were evaluated. All patients were regularly followed up.Results Dysfunction occurred in one graft kidney 5 years after the operation, and the patient died of cardiovascular complication 8 years after the operation. The remaining 2 patients have survived 22 and 2 months respectively with normal renal function, and their Rh antibodies were negative 21 and 2 months after the operation respectively.Conclusion Fully perfused Rh-positive renal grafts can be transplanted to Rh-negative uremia patients. The short-term effect is satisfactory.

Objective:To observe the outcome of clinical treatment of advanced pancreatic carcinoma in patients who were unable to bear surgery and underwhent regional chemotherapy.Methods:42patients who were diagnosed through exploration of pancreatic carcinoma that could not be treated by radical re-section were given regional chemotherapy.Through laparotomy a catheter was inserted into the gastroduo-denal artery or right gastroepiploic artery and a bolus of 5-FU at the dose of 1g was infused through the catheter during operation.5-FU at the dose of 1g was infused during weekly after operation.Results:No severe complications or side effects were found in any patient,most symptoms were relieved or disappeared,the middle survival time rose to8.2months (P0.05),and the serum concentration of CA19-9became lower than that before the therapy.Conclusion:Regional chemotherapy has advantages of fewer side effects and complications,and can relieve clinical symptoms and prolong survival time.