Objective To explore a new therapeutic method to intractable rejection after liver transplantation.Methods Low dose prograft and rapamycin were given to 2 patients with intractable acute rejection and 2 patients with intractable chronic rejection confirmed by biopsy after liver transplantation, which had no response to normal treatment. The blood concentration of prograft was controlled in 3～5 ?g/L and rapamycin in 6～12 ?g/L. Rapamycin was withdrawn and prograft was increased to normal dose while the rejections were rectified.Results Four allograft rejections were all reversed in the end with this method. In the course of this therapy, one of the 4 patients had CMV pneumonia and cured with antiviral therapy. One had diabetes and another's diabetes got more critical. The blood glucose recovered to the primary level after the withdrawal of rapamycin.Conclusion The intractable acute and chronic rejection which has no response to normal treatment can be reversed by combined use of low dose prograft and rapamycin.

Objective To discuss the long-term effect of orthotopic liver transplantation to patients with hepatic myelopathy. Methods The clinical data of 2 patients with hepatic myelopathy undergoing liver transplantation were analyzed retrospectively. The condition of recovery of muscle strength of the patient's double lower limbs was carefully observed both pre-and post operatively. Results The patient's clinical symptoms were well improved and liver function recovered to normal. Hepatic myelopathy was controlled. The follow-up duration of 2 cases was 18 and 43 months respectively. The muscle strength of lower limbs was recovered from 1 degree to 3 and 4 degree respectively. Conclusion Liver transplantation can effectively control the development of hepatic myelopathy and it is obviously useful for recovery of double lower limbs.

Objective To evaluate the application of artificial liver support system (ALSS) in severe hepatitis patients before liver transplantation. Methods Double lumen catheters were inserted into the femoralvein to construct the blood conduit in patients receiving ALSS. The blood purification apparatus was applied for plasma replacement and blood perfusion with PIS separator and HA hemoperfusion apparatus. The plasma replacement capacity was 3000ml-4000ml (average 3200 ml) with albumin 20g. The average dosages of both heparin and protamine were 25 mg. The separation speed was 26 ml/min. The replacement blood flow was 100-150 ml/min, and the average treatment time was 120 min. Results The liver function markers, including TB, DB, ALT, AST and NH 3, were improved in patients with ALSS. Conclusion ALSS could correct the imbalance of homeostasis of the patients, eliminate the toxic substances effectively and provide valuable support for liver transplantation.

Objective To explore causative factors, and prevention and treatment of nonanastomotic biliary stricture (NABS) after orthotopic liver transplantation. Methods The donor’s liver together with celiac artery and its branches were havvested rapidly without injury to reduce heat ischemia time and artery loss, then the bilinary duct was flushed to clean out residual bile. During operation, when the portal vein was opened, the hepatic artery of the donor liver was flushed with heparin saline. Post-operatively, acute or chronic rejection and cytomegalovirus infection should be prevented. When NABS occurred, it was treated with bilinary balloon dilatation. Results Of 36 patients with liver transplantation, 4 patients (11.1%, 4/36) were found to suffer from NABS. Two patients were cured, in one patient it was improved after dilatation, and one patient died. Conclusion NABS is mainly related to artery loss, cold/warm ischemia injury, ischemia/reperfusion injury, bile toxicity injury, immune injury and cytomegalovirus infection etc. Biliary balloon dilatation is the major treatment for NABS. Retransplantation is necessary for some severe cases.

Objective To explore the evidences of the humoral factor involved in the liver allograft rejection, and to explore better monitoring methods and therapy of the humoral liver rejection. Methods After the humoral liver rejection, liver puncture biopsies were performed. Immunohistochemical examinations of C4d, CD20+ B lymphocytes and CD138+ plasma cells were performed to judge whether humoral factor was involved in liver rejection. The dosage of tacrolimus was increased first when rejection was identified. The patients with severe liver function damage were treated with methyllprednisolone, and the steroid-insensitive cases were treated with antithymocyte globulins (ATG) and rapamycin. Results 25 biopsies were performed in 16 patients. Humoral rejection was diagnosed for 15 times in 10 patients, cellular rejection was diagnosed for 6 times in 4 patients, and the both kinds of rejection occurred in the last 2 patients. The effect of methylprednisolone was obviously lower in the humoral rejection cases (29.4%, 5/17) than that of the cellular rejection cases (7/8). Steroid-insensitive humoral rejections were diagnosed in 12 biopsies from 7 patients receiving liver transplantation. One patient was cured with ATG and 5 patients were cured with addition of rapamycin. The case whose blood type was AB receiving a liver transplant from the donor of O blood type died of liver function failure even after an extensive treatment. Conclusions Humoral immune factors maybe involved in some acute and chronic liver allograft rejection. ATG and rapamycin are more effective for the patients with humoral liver rejection.

Objective To study the education of medical mycology for undergraduates of medical laboratory specialty and provide a basis for teaching reformation.Method Setting of mycology related courses of medical mycology for undergraduates in 5 medical schools and 85 inspection and technical personnel's detection of fungi in 81 hospitals were investigated through consultation and questionnaire survey.Results More than 140 class hours for medical mycology were arranged in 5 schools,but as to medical mycology,22 class hours in 1 school and less than 10 class hours in 4 schools,the minimum class hours were 5.Although various numbers of Candida and filamentous fungi could be isolated in hospitals investigated,more than half laboratory workers could not identify penicillium,thermally dimorphic fungi,Zygomycetes and Dematiaceous fungi.Conclusion Education on medical mycology for medical laboratory specialty undergraduates is insufficient and the corresponding teaching lacks such content as medically important pathogenic fungi detection methods and identification characteristics.The hospital technical personnel's fungal identification ability cannot meet the situation of increasing fungal infection involved in clinical medicine,so it is necessary to carry out teaching reformation of medical mycology for undergraduates in laboratory medicine,including adding class hours,increasing course contents and so on.

Objective To evaluate the efficacy and security of splenic artery ligation for severe hypersplenism during liver transplantation.Method Thirty-two liver transplant patients with preoperative hypersplenism were selected,including 17 cases (ligation group) treated by splenic artery ligation during liver transplantation,and rest 15 patients as non-ligation group.The fluctuation of white blood cells,platelets and volume of spleen were compared between these two groups.At the same time,splenic infarction,postoperative infection,recurrent gastrointestinal bleeding,splenic artery steal syndrome and other complications were observed in these two groups.Result All recipients were followed up for over 6 months.One recipient in ligation group died of multiple organ dysfunction caused by delayed recovery of liver donor with the survival rate being 94.1％ (16/17).The survival rate in non-ligation group was 93.3 ％ (14/15) (one recipient died of respiratory failure caused by pulmonary infection).There was no statistically significant difference in survival rate between these two groups (P＞0.05).Splenic necrosis wasn't detected in the ligation group.The splenic volume in ligation group was significantly less than that in non-ligation group (P＜0.01).The products of splenic maximum length and wide diameter shrunk 33.17-± 8.26 cm2 and 22.47 ± 7.25 cm2 in ligation group and non-ligation group,respectively.The platelet counts of ligation group were significantly greater than those of non-ligation group in all the observation points within 6 postoperative months (P＜0.01).The white blood cell counts of ligation group were greater than those of non-ligation group at the first week postoperatively (P＜0.01),whereas,there was no statistically significant difference between these two groups from then on (P＞0.05).The infection incidence of ligation group was lower than that of non-ligation group within 6 postoperative months (P ＜0.05).Statistically significant differences in recurrent gastrointestinal bleeding and splenic artery steal syndrome weren't found between these two groups (P＞0.05).Conclusion Splenic artery ligation in liver transplantation is safe and effective.It can rapidly increase the counts of platelet and white blood cell in the earlier postoperative time,which is beneficial to patient's recovery.Besides,it adds no correlative complication.

BACKGROUND: Hepatic myelopathy results from liver disease, which lacks of effective cure method. Liver transplantation has attempted to cure this disease; however, the long-term therapeutic effect is rarely reported. OBJECTIVE: To explore the long-term therapeutic effect of liver transplantation in patients with hepatic myelopathy. METHODS: The clinical data of 2 patients with hepatic myelopathy, who underwent orthotopic liver transplantation, in August 2002 and November 2004, at the 309 Hospital of Chinese PLA, were analyzed retrospectively. The time of follow-up was 18 and 43 months, respectively. The muscle strength of double lower limbs in 2 patients was assessed prior to and after operation. RESULTS AND CONCLUSION: Two patients recovered well at 4 weeks after transplantation, the clinical symptom and physical signs of patients were improved obviously, the blood routine examination and other biochemical index were normal,and the function of transplanted kidney was normal. Two patients discharged at 6 weeks after transplantation. Patient 1 could stand for a long time at months 6 after transplantation, walked slowly with the supporter after 12 months and without the supporter at 43 months. The muscular strength of two lower limbs was grade 4. And the liver function was normal. Patients 2 could move his lower limbs in bed at months 6 after transplantation, walked with the supporter at 18 months. The muscular strength of two lower limbs was grade 3. The liver function was normal. It demonstrated that liver transplantation is beneficial to control hepatic myelopathy and recover muscular strength of two lower limbs. It is a newly developed, effective curing method for treating hepatic myelopathy. However, the numbers were small with short time observation, thus, the long-term therapeutic effect still need to be explored.

This study raised the necessity of developing performance indicators for measuring the management efficiency and effectiveness of school food service, and as a means of helping its implementation, a balanced score card (BSC) approach developed by Norton and Kaplan was adopted. This study established BSC in seven phases through literature: Phase 1 Defining a school food service and the scope of working activities, Phase 2 Establishing the vision of a school food service, Phase 3 Setting strategic goals, Phase 4 Identifying critical success factors (CSFs), Phase 5 Developing Key Performance Indicators (KPIs), Phase 6 Extracting cause and effect relationship, and Phase 7 Completing a preliminary BSC. The preliminary BSC was turned into a survey, which was administered to food service related people working at the Office of Education and School Food Service including 16 offices, 209 dietitians, 48 school administrators both from self-operated and contract-managed, and 9 experts in areas related to school food service. They were asked questions about strategics from 4 different perspectives, 12 CSFs, 39 KPIs, and the cause and effect relationships among them. As a result, among the CSFs based on 4 different perspectives, all factors other than "zero sum on profit/loss" from the financial perspective turned out to be valid. In terms of KPIs, manufacturing cost percentages, casualty loss count/reduction rates, school foodervice participation rates, and sales goal achievement rates were found to be valid from the financial perspective, while student satisfaction index, faculty satisfaction index, leftover ratio, nutrition educational performance count, index of evaluating nutrition education, customer claim count/reduction rate, handling customer claim count/reduction rate, and parent satisfaction index were found to be valid from the customers' perspective. Besides, nutritional requirement sufficient ratio, nutritional management score, food poisoning outbreak count, employee safety accident count, sanitary inspection assessment index, meals per labor hour (productivity index), computerization ratio, operational management index, and purchase management assessment index were also found to be valid from the perspective of internal business processes. From the perspective of innovation and learning, employee turnover ratio/rate of absenteeism, annual education and training count, employee satisfaction index, human resource management assessment index, annual menu-related customer feedback, food service information index for employees and parents/schools were also found to be valid. The significance of this study is to present indices for measuring overall performance of school lunch food service operations without putting any limitation on types of school food service management, and to help correctly assess the contribution of the current types of school food service management to schools and students.
Absenteeism ; Administrative Personnel ; Commerce ; Education ; Food Services* ; Foodborne Diseases ; Humans ; Learning ; Lunch ; Meals ; Nutritional Requirements ; Nutritionists ; Parents ; Personnel Turnover

OBJECTIVE To evaluate the antibacterial effect of cefoperazone-sulbactam combined with minocycline or levofloxacin against 110 strains of multidrug-resistant Acinetobacter baumannii.METHODS Checkerboard method was designed for the minimal inhibitory concentration(MIC) testing of cefoperazone-sulbactam combined with minocycline or levofloxacin against 110 strains of multidrug-resistant A.baumannii by agar dilution method,fractional inhibitory concentration(FIC) index was calculated according to MIC value.RESULTS The MIC50 of cefoperazone-sulbactam was reduced significantly and the antimicrobial activities were reinforced remarkably when combined with minocycline or levofloxacin.The FIC results suggested that the main action be synergistic and additivie(53%,59% and 39%,37%),there was less autonomy(8%,4%) and no antagonism.CONCLUSIONS Combined with minocycline or levofloxacin respectively,cefoperazone-sulbactam expresses synergism and additivity against multidrug-resistant A.baumannii and there is no autonomy and antagonism.