AIM:Anti-hepatis B immunoglobulin in combination with lamivudine is efficient to prevent chronic hepatitis B virus (HBV) reinfection following liver transplantation. However, long-term usage of lamivudine can result in YMDD variation and lead to medicine resistance even HBV relapse. In this study, we investigated etiological factors and prevention and treatment protocol of HBV recurrence and YMDD variation after liver transplantation. METHODS:A computer-based online search of Pubmed database from January 2002 to January 2008 and Chinese Journal Full-text Database from January 2003 and December 2007 was undertaken to identify articles about HBV recurrence and YMDD variation after liver transplantation. The collected articles were firstly selected and the references of each article were looked up. Only articles that involved in HBV recurrence and YMDD variation after liver transplantation were included. The articles published in authoritative journals in recent 5 years were accepted in priority. Repetitive articles and Meta analysis were excluded. RESULTS:HBV recurrence after liver transplantation is associated with hepatitis B DNA loading dose, invasion of hepatitis B into non-liver tissues, immunosuppressive therapy and viral genovariation. The major prevention and treatment protocol of HBV reinfection after liver transplantation is the combination of anti-hepatis B immunoglobulin and lamivudine, which is economical and efficient. However, long-term administration of lamivudine induces YMDD variation in hepatitis B DNA polymerase, leading to drug resistance even HBV recurrence. Now adefovir dipivoxil is regarded as an effective remedy for YMDD variation. CONCLUSION:Virus variation and HBV recurrence can influence prognosis of HBV-related end-stage diseases after liver transplantation. Prevention and cure approaches are developing. It is important to find an economic, safe, convenient and effective therapeutic regimen. In addition, individualized treatment and the evaluation of risk and advantage should be emphasized.

Objective To explore the effect of nitric oxide(NO) on pulmonary tumor necrosis factor?(TNF?) in murine acute necrotizing pancreatitis(ANP). Method Ninety-six SD rats were randomized into four groups:normal control group, ANP group, L-Arginine(L-Arg) pretreatment group and L-NAME pretreatment group (n=24 for each group). The protein content of bronchoalveolar lavage fluids(BALF), the myeloperoxidase(MPO) of lung tissue and TNF? produced by alveolar macrophages were evaluated. The expression of TNF? mRNA was measured. ResultMPO and protein of BALF reached a peak level at 12nd hr (10.78?0.58U/g for MPO and 2011?106?g/ml for protein content respectively).TNF? peaked on the sixth hour(1624?149)pg/ml. The expression of AM TNF?mRNA also peaked on the sixth hour (1.127?0.069) along with an increase of TNF? mRNA. A similar tendency was seen in L-Arg and L-NAME pretreatment groups, with changes being statistically different in the three groups when compared with that of normal control group(P

Hepatic myelopathy is a rare disease with high mortality. There has been no report of an effective treatment to date. In order to evaluate the beneficial effect of orthotopic liver transplantation in patient with hepatic myelopathy. One patient, who was suffering from hepatie myelopathy complicating hepatic pathology, underwent liver transplantation in 2002 was studied. The muscle strength of the patient’s extremities was carefully assessed both pre-operatively and postoperatively. It was found that symptoms and signs of hepatic myelopathy were improved, especially the muscle strength recovered from 1-2 degree to 3-4 degree half a year after the operation. Therefore it is our belief that liver transplantation might be beneficial to patients who are suffering from hepatic myelopathy as a complication of the hepatic disease.

Objective To observe the therapeutic effects and side-effects of tacrolimus (FK506) in the recipients who had undergone liver transplantation, and summarize the clinical experience of its use. Method The clinical data of 36 recipients of allogeneic liver transplants followed by tacrolimus-based anticoagulant regimen were retrospectively analyzed. After liver transplantation, all the recipients received the triple-drug immunosuppressive protocol, including tacrolimus as the basic drug, mycophenolat-mofetil (MMF), and prednisone. Twenty-four of 36 cases received Zenapax as an antibody induction therapy. Results Acute rejection occurred in 3 of 36 cases. After the use of methylprednisolone and OKT3, acute rejection was reversed. The main side-effects of tacrolimus were nervous system disturbance(40.0%), hypertension(13.3%), hyperglycemia(26.7%), and liver dysfunction(6.7%). Conclusion Tacrolimus is a safe and potent immunosuppressive agent, which can decrease the incidence of rejection in liver transplant recipients. The dosage of tacrolimus should be adjusted according to trough level with in the therapeutic window. The timely and appropriate adjustment of the immunosuppressive strategy is essential for the recipient and graft survival. Meanwhile, it is emphasized that the regime should be individualized. [HS(1*2/3]

Objective:To investigate the protection mechanism of rosavin in learning and memory ability in subacute aged rats in-duced by D-galactose. Methods:Totally 48 SD rats were randomly divided into the normal group, model group, positive drug group, and rosavin group respectively at the dose of 6, 12 and 24 mg·g-1 . Except the normal group, the other rats were with neck subcuta-neous injection of D-galactose 120 mg · kg-1 · d-1 . After 4-week drug administration, the learning and memory ability of rats was studied using Morris water maze. PO2 , SaO2 , the activity of superoxide dismutase ( SOD) , catalase( CAT) and glutathione peroxidase ( GSH-Px) and the content of O2 and malonaldehyde( MDA) of rats in vivo were determined at the end of the experiment. Results:The aged rats treated with rosavin(12 or 24 mg·kg-1·d-1) were with significant shortened latent period in Morris water maze(P<0. 01 or P<0. 05), and with reduced total swimming distance and error angle. Meanwhile, rosavin(6,12 or 24 mg·kg-1·d-1) could im-prove the concentration of O2 ,PO2 and SaO2 , the activity of SOD, CAT and GSH-Px in brain, while decrease the content of MDA with certain dose-effect relationship. Conclusion:Rosavin can inhibit D-galactose induced learning and memory decrease in rats, and the effect may be related with the increase of oxygen content, enzyme activity protection of SOD, CAT, MAO and GSH-Px and decrease of MDA generation.

ObjectiveTo study the clinical features of stercoral bowel obstruction and perforation of colon in elderly patients MethodsThe data of 22 cases of stercoral bowel obstruction and 6 cases of stercoral perforation of colon in elderly patients in our hosital from January 1994 to December 2003 were analyzed retrospectively ResultsIn the 22 cases with stercoral bowel obstruction, 6 cases were recovered after operation, 6 cases suffered from stercoral perforation in which all cases were misdiagnosed before operation,and 2 cases were dead.ConclusionsThe prevalence of stercoral bowel obstruction and perforation of colon in elderly patients are increasing with population being aged. The cases without perforation are often recovered by non-operative therapy. The perforation case of stercoral bowel obstruction is relatively rare, easy to be misdiagnosed, and in high mortality. The Hartmanns ostomy should be the choice for the perforation.

Artery cannulation is one of the clinical skills that should be mastered by the internships of anesthesiology. In consideration of its invasiveness,teachers should carry out the clinical teaching strictly and patiently,and assist the internships to establish a correct opinion on clinical practice. We should train the internships step by step,improve their success rates on artery cannulation and avoid complications as far as possible.

Objective To survey the value of risperidone in the treatment of depression without psychotic symptoms. Methods 205 depressive patients were randomly divided into 3 groups: risperidone group, fluoxetine group and combined group (risperidone+fluoxetine). They were assessed with Hamilton Depression Scale (HAMD), Treatment Emergent Symptom Scale (TESS) before treatment and in 2nd week, 4th week, 6th week and 8th week after treatment. Results The reduction rate of HAMD of combined group was the best among three groups(P<0.05), and that of fluoxetine group was better than that of risperidone(P<0.01). The significant difference in reduction rate of HAMD between combined group and other two groups was observed since 2nd week after treatment(P<0.05). No difference in scores of TESS has been observed in any time among three groups. Conclusion Risperidone can improve the efficacy of fluoxetine on depression without psychotic symptoms without increasing side effects, but itself is less effective than fluoxetine.

Objective The exam quality of ‘Probability’ course for foreign medical undergraduates was analyzed,aiming at providing some reference for the improvement of the student evalua-tion system and course quality.Methods The ‘Probability’ course exam scores of 167 foreign un-dergraduates of 2014 batch were collected,the students were divided into two classes according to their entrance date,the former part class A consisted of 90 students,the latter part class B consisted of 77 students.The reliability of the test paper was judged according to Cronbach's α,Hotelling's T2 and Pearson correlation coefficient.The Spearman correlation analysis was adopted to evaluate the cor-relation between the question items.For the two classes,the impact of the entrance time on the test scores was explored on the basis of Student's t-test of question item scores and the total scores.Results The average score of the course exam was 82.587 points with the standard deviation of 13.520,Kol-mogorov-Smimov statistic was 1.627 (P=0.010),the exam scores could not follow normal distribution.The Cronbach's α for the exam paper was 0.808,the standardized Cronbach's α was 0.815.The Spearman correlation coefficients between the five question items were all with statistical significance and varied from 0.315 to 0.657.As the students were divided into two classes according to their entrance date,for the ‘Probability’ section scores of the latter batch students were less than the scores of the former batch,with the difference 4.017 points,the same situation was also found that all the five items in the ‘Probability’ section.Conclusions The entrance time for the foreign medical freshman has an impact on their exam scores,suggesting that more attention should be paid to those students.

Objective To study the correlation between the risk factors of coronary slow flow phenomenon ( CSF) and the level of plasma D-dimer in patients with ACS ( acute coronary syndrome) after emergency percutaneous coronary intervention ( PCI) .Methods A total of 297 patients with ACS after PCI were enrolled for retrospective analysis.All patients were divided into CSF group and control group in the light of corrected thrombolysis in myocardial infarction (TIMI) frame count method (cTFC).Multivariate analysis for evaluating clinical predictors of CSF was carried out using Logistic regression test and Pearson analysis to find the correlation between plasma D-dimer and cTFC.The predictive value of D-dimer level in the occurrence of coronary slow flow was determined by using receiver operating characteristic ( POC) curve analysis.Results CSF was observed in 59 cases (19.8%).The plasma D-dimer was significantly higher in the coronary slow flow group compared with the control group ( P <0.05 ) .Multivariate regression analysis and Logistic regression test showed that the level of plasma D-dimer ( OR =1.276, 95%CI:1.132-3.224, P=0.012), thrombus score (OR =1.108, 95%CI: 1.085-2.103, P =0.018) and target lesion length of culprit vessel ( OR =1.436, 95%CI: 0.635-1.382, P =0.037 ) were the risk factors of CSF.Correlation analysis showed that plasma D-dimer were positively associated with CSF. Receiver operating characteristic ( ROC ) curve analysis showed that D-dimer cutoff point at 515.3 ng/ml had a good judgment significance ( AUC 0.783, OR =1.502, 95%CI: 1.324-2.531, P =0.005). Conclusions The increased D-dimer level is a risk factor and plays an important role in the ACS patients with the CSF phenomenon, thereby predicting no-reflow phenomenon after primary PCI in these patients.