ObjectiveTo observe the postoperational curative effect and complicational occuring status by using soft palate landscape orientation two fusiform cuts and enlarge two amygdales resection to treat(obstructive sleep apnea hyponea syndrome,OSAHS).Methods59 cases with type Ⅰ OSAHS were divided into experimental group(39 cases)using soft palate landscape orientation two fusiform cuts and enlarge two amygdales resection,control group( 20 cases)carrying out UPPP or keeping uvula UPPP.ResultsTow groups postoperational total effective rate 84.75％ (50/59),PSG survey's analysis( x2 =6.348,P ＜0.05 ) with preoperation,postoperation,without obvious discrepancy,the degree of postoperational pharyngeal ache,after follow-up visit 6-12 months,comparing the changes of snore,nasopharynx's backflow or missing deglutition and appearing cavum pharyngis coarctation( U =3.426,P ＜ 0.05 ),having outstanding discrepancy.ConclusionIt was not only to completely keeping uvula by using soft palate landscape orientation two fusiform cuts and enlarge two amygdales resection to treat OSAHS,but to enlarge soft palate shaping confines,not only effectively enlarging the ventilate's sectional area of cavum oropharyngeum,but preferably keeping the normal physiological morphology and function of cavum pharynges,avoiding the happening such as palatepharynx insufficiency complication etc.

Objective To explore the prevalence of osteoporosis (OP) and vertebral osteoporotic fracture (OPF) and related risk factors in patients with rheumatoid arthritis (RA).Method A total of 644 patients with RA from Jan.2010 to Oct.2013 were recruited,anteroposterior and lateral X-rays examination of vertebral column (T5-L5) were conducted,and semi-quantity method were used as the standard for judging vertebral OPF.Meanwhile,patients' clinical and laboratory data including daily dosage of glucocorticoid,duration of glucocorticoid usage,cumulative amount dosage of glucocorticoid were recorded in details.158 normal subjects were selected as control group.Results (1)The prevalence of vertebral OPF in patients with RA was 16.6％.Bone mineral density (BMD) of all measured lumbar vertebra in RA group were markedly decreased[(0.97 ±0.22) g/cm2].The total prevalence of OP at lumbar vertebra in RA was 17.9％ (81/452),which was significantly higher than that of control group (4.4％,7/158) (P ＜ 0.001).(2) The percentage of OP in RA patients with vertebral OPF was significantly higher than that in patientswithout OPF [40.6％ (41/101) vs 11.4％ (40/351) ;P ＜ O.001].Patients with OPF were of older age,longer use of glucocorticoid,more cumulative amount dosage of glucocorticoid,longer disease duration,higher scores of health assessment questionnaires (HAQ) and increased ESR (P ＜ 0.05).(3) Logistic regression analysis revealed that age (OR =1.094,95％ CI 1.065-1.125,P ＜0.001) and gender(1 =male,2 =female) (OR=5.600,95％ CI 2.097-15.087,P =0.001) were the risk factors for the development of OP in RA,while body mass index (BMI) was the protective factor (OR =0.770,95％ CI 0.696-0.853,P ＜ 0.001).Age (OR =1.031,95％ CI 1.009-1.053,P =0.005) and occurrence of OP at lumbar vertebra (OR =3.765,95％ CI 2.092-6.776,P ＜ 0.001) were risk factors of the development of OPF in RA patients.Logistic regression analysis also showed that RA was the risk factor of OPF (OR =4.716,95％ CI 1.987-11.192,P ＜ 0.001),even after the adjustment of age,gender and BMI.(4) Receiver operator characteristic(ROC) curve in RA patients with OPF has found that age-OPF and daily dosage of glucocorticoid-OPF AUCRoC were 0.689 and 0.636 respectively.The cut-off value in ROC curve of age and daily dose or treatment course of glucocorticoid-OPF were 54.5 years and 6.25 mg(P ＜0.001),while duration of glucocorticoid usage-OPF AUCROC was 0.685,with cut-off value in ROC of age-OPF 135 days(P ＜ 0.001).Conclusion Prevalence of OPF in patients with RA increases remarkably.Old age and OP at spine are risk factors related to the development of OPF in patients with RA.

Objective To investigate the value of serum receptor activator of nuclear factor kappa B ligand (RANKL)/osteoprotegrin (OPG) ratio in osteoporotic fracture (OPF) of patients with rheumatoid arthritis (RA).Methods Three hundred and eighty four RA patients with mean age of (49 ± 14) y (16-82) admitted in the First Affiliated Hospital of Anhui Medical University from 2010 to 2013 and 158 sex-and age-matched healthy subjects were enrolled in the study.OPF was diagnosed by X-ray examination and BMDs of femur and lumbar spine 2-4 (L2-4) were measured by dual energy X-ray absorptiometry.Levels of RANKL and OPG in the peripheral blood of 220 RA patients and 100 normal subjects were detected by ELISA method.Results Eighty-two cases of OPF was diagnosed in 384 RA patients (21.35％),the rate was higher than that in controls (3.80％,6/158,x2 =25.371,P ＜0.01).The peripheral blood levels of RANKL (0.150 ± 0.143 vs.0.101 ± 0.066,t =4.178,P ＜ 0.01),OPG (0.457 ± 0.293 vs.0.359 ±0.216,t=3.347,P=0.001) and ratio of RANKL/OPG (0.41 ±0.35 vs.0.34±0.20,t =2.111,P=0.036) in RA patients were significantly higher than those in control group.In comparison with normal controls,BMDs of all detected regions in RA were decreased significantly (P ＜0.01).The incidence of osteoporosis in RA (121/327,37％) was higher than that in normal controls (22/158,13.92％) (x2 =27.291,P ＜ 0.01).RA patients with OPF had higher age (t =4.377,P ＜ 0.01),longer duration of disease (t =2.612,P =0.009),higher RANKL level (t =3.554,P =0.001),higher RANKL/OPG ratio (t =2.651,P =0.010),higher health assessment questionnaires (HAQ) score (t =2.418,P =0.016),lower serum calcium level (t =2.183,P =0.030),lower hemoglobin level (t =2.125,P =0.036),higher Sharp score in hands X-ray examination (t =2.747,P =0.007),worse X-ray stage (x2 =7.856,P =0.049),higher glucocorticoid utilization rate (x2 =9.066,P =0.003) and higher incidence of osteoporosis (x2 =38.186,P ＜ 0.01),compared with patients without OPF.RA patients taking corticosteroids had higher incidence of osteoporosis (x2 =7.489,P =0.006) and higher incidence of OPF (x2 =9.066,P =0.003).Logistic regression analysis showed that age (OR =1.029,P =0.039,95％ CI:1.001-1.057)and the occurrence of osteoporosis (OR =3.159,P =0.001,95％ CI:1.562-6.385),RANKL/OPG ratio (OR =3.516,P =0.013,95 ％ CI:1.305-9.647) were risk factors for RA patients with OPF.Conclusion A higher incidence of OPF is prevalent in RA patients,and age,osteoporosis,taking glucocorticoids and RANKL/OPG ratio are risk factors for OPF in RA patients.

Objective To examine the plasma β-catenin and DKK1 levels in patients with rheumatoid arthritis (RA) and to explore their relationship with bone and joint damage in RA.Methods One hundred and thirteen patients with RA and 120 healthy individuals were recruited into this research.Bone mineral density (BMD) in the femur and lumbar spine were measured with dual-energy X-ray absorptiometry (DEXA).Radiographs for two hands were evaluated according to the Sharp's method.Serum levels of β-catenin and DKK1 in all patients with RA and healthy controls were detected by enzyme-linked immunosorbent assay (ELISA).The 2-tailed independent samples t test was used for measurement data.Chi-square test was used for the enumeration data.Correlation analysis,linear regression and Logistic regression analysis were used as appropriate statistical analysis.Results ① Significantly higher serum levels of DKK1 were observed in RA patients than that in healthy controls [(8±7) vs(6±4) μg/ml,t=2.552,P=0.012],while there was no sinnificant difference with regard to the levels of β-catenin between the two groups.② Compared to control groups,patients with RA had lower BMDs at femur and lumbar spine (P＜0.01).Furthermore,incidence of osteoporosis (OP) in RA (31.9％,36/113) was remarkablely higher than that in healthy subjects (15.0％,18/120) (x2=9.290,P=0.002).③ There were obvious discrepancies in age,swollen joint count (SJC),swollen joint count index (SJI),alkaline phosphatase (AKP),joint narrowing space score,joint erosion score,Sharp score between patients with osteoporosis and without osteoporosis (P＜0.05).④ In RA group,DKK1 level was posi-tively related with plasma erythrocyte sedimentation rates (ESR),28-jonit disease activity score (DAS28),AKP,joint narrowing space score (P＜0.05).Serum β-catenin level was associated with ESR,AKP in RA (P＜0.05).⑤ Multiple linear regression analysis indicated that in the RA group,disease duration (b=0.709,t=9.560,P＜0.01,95％CI:2.154-3.286),HAQ (b=0.151,t=2.052,P=0.043,95％CI:0.234-15.243),DKK1(b=0.286,t=2.057,P=0.043,95％CI:0.034-2.028)were the contributors for joint space narrow score(R2=0.580,F=24.745,P＜0.01).⑥ Multiple Logistic regression analysis showed that the Sharp score (OR=1.018,P＜0.01,95％CI:1.008-1.028) was the risk factor for the occurrence of osteoporosis at femur in RA,while age (OR=1.087,P=0.012,95％CI 1.019-1.159) was the risk factor for osteoporosis at lumbar spine.Conclusion Serum DKK1 levels in RA increase significantly,while there is no apparent alteration in plasma β-catenin.Serum DKK1 is correlated with disease activity and joint space narrow score.

BACKGROUND: Tumor recurrence in liver transplant recipients greatly affects prognosis of liver transplantation with hepatocellular carcinoma (HCC). How to prevent tumor recurrence has aroused increasing attention. Arsenious acid chemotherapy is considered effective on treating moderate or advanced liver cancer, but its utilization following liver transplantation remains few. OBJECTIVE: To explore the role of arsenious acid on tumor recurrence in liver transplant patients with primary HCC extending Milan criteria. RESULTS AND CONCLUSION: All patients were routinely followed up for 3-32 months. Thirty recipients were presented with tumor recurrence, 16 in the chemotherapy group and 14 in the non-chemotherapy group. Tumor recurred in lung, liver graft and bones in most cases. The total recurrence rate was similar in these two groups, but chemotherapy could delay recurrence after transplantation (P=0.026). There was no significance in 6-month, 1-year survival rate between two groups, but the 2-year survival in the chemotherapy group was higher (P=0.037); 6-month tumor-free survival rates in the two groups had no significance, 1-year and 2-year tumor-free in the chemotherapy group were significantly higher than those in the non-chemotherapy group (P=0.030, 0.023). Intravenous arsenious acid chemotherapy can delay tumor recurrence and prolong survival in liver transplant patients with HCC extending Milan criteria.

Objective To analyze the surgical procedure and effect of living-related small bowel transplantation(LR-SBTx) on intestinal function failure caused by short bowel syndrome.Methods A boy, 15 years of age with short gut syndrome, who had only 8 cm of residual small intestine, associated with serious malnutrition and poor D-xylase absorption test (0.226/5h). The donor was the boy's mother. They had a match of 4 loci in HLA. In the first stage of the surgical procedure, 120 cm of ileum from the patient′s mother was transplanted into the recipient. Both ends of the transplanted intestine were exteriorized as stomas on the patient′s abdominal wall. The second stage of reconstruction of the intestine was carried out 6 months after his first operation. The residual small bowel of the recipient was transected, and both of its ends were respectively anastomosed end-to-side to the proximal and distal segments of the graft. The stomas of the graft were left in place. Results The donor and recipient operation went on smoothly. Acute rejection and infection of CMV developed postoperatively and were cured after treatment. The patient was followed-up for 8 months, the graft function recovered gradually postoperatively with increase of body weight. He can ingest a semifluid diet and take care of himself independently. Conclusions LR-SBTx is an effective way to treat short bowel syndrome. The reconstruction of the intestine in two stages for LR-SBTx decreased the risk of complications. Rejection and infection are important risk factors of LR-SBTx.

Objective To evaluate the impact of steatotic hepatic grafts on postoperative early liver function and prognosis.Methods Clinical data of 35 cases receiving steatotic liver grafts in our hospital were retrospectively analyzed.The donor liver grafts were divided into 3 groups based on the degree of fatty infiltration(＜20%group,20%～40%group,≥40%group).Results were compared with that from control normal grafts(41 cases).Liver function parameters including AST,ALT,TB,PT on the day of surgery and 1,2,3,7 days later were monitored among the 4 groups,as well as the incidence of delayed nonfunction (DNF),and 3 and 6 months patient survival rate.Analysis of the correlation between degree of donor steatosis and liver function after operation was carried out.Resuits There was significant difference in postoperative ALT、AST、TB、PT level between≥40%group and 20%～40%group,and between 20%～40%and group＜20%group.There was no significant difference among the groups in DNF occurrence rate and 3 month.6 month patient survival rate.Correlation analysis suggested that the degree of donor steatosis was positively correlated with the damage of liver function.Conclusions Grafts with≤20% steatosis was safe,whereas≥20% especially ≥40% steatosis carries a high risk of posttransplant liver dysfunction even delayed nonfunction.

Objective To investigate the diagnosis,and management of aspergillosis infection in orthotopic liver transplant recipients.Methods The clinical data of 776 cases of orthotopic liver transplantation patients from 2000 to 2006 were collected and analyzed retrospectively.Results Aspergillosis infection occurred in 13 patients(1.68%),among those there were pulmonary aspergillus infection in 7 cases,hepatic aspergillus infection in 2,cerebral aspergillosis in one and multi-organ aspergillosis in 3.Liposomal amphotericin B was the main therapy especially for cases at early stage.7 patients died of aspergillosis and the aspergillosis-related mortality was 53.8%.Conclusion Early diagnosis and management remain the key for the prevention and cure for aspergillus infection and decreasing mortality.The use of anti-fungal therapy should follow the principle of eliminating the local infection,adjusting immunosuppressive regimen and use of sensitive anti-fungal drugs.Anti-fungal drugs should be started early,with sufficient dosage and long-term.

Objective To investigate the efficacy and safety of sirolimus in treating calcineurin inhibitor-related renal insufficiency after liver transplantation. Methods Eleven patients with calci-neurin inhibitor-related renal insufficiency after liver transplantation received sirolimus conversion.Simultaneously, the dose of tacrolimus was decreased or tacrolimus was withdrawn. Blood creatinine,sirolimus level, tacrolimus level, liver function, rejection episodes and drug side-effect were moni-tored. Results All the 11 patients survived today with 6 to 20 months of follow-up. All patients showed improvement of renal function after conversion to sirolimus. Blood creatinine level was reduced from (163.8±47.9)μmol/L to(108.1±26.6)μmol/l. (P<0.05). One patient's liver function had an acute rejection episode that was successfully treated with increase of dose of tacrolimus. The side-effects of sirolimus included hyperlipidemia (4 patients), anaemia (1) and mouth ulcers (2).Conclusion Siolimus can be effectively and safely used in liver transplant recipients suffering from ta-crolimus-related renal insufficiency.

Objective To explore the outcome and treatment for recipients with steroid-resistant acute rejection (SRAR) after liver transplantation. Methods From Jan 2004 to Dec 2007, 596 adult patients received liver transplantation in the Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-Sen University,96 recipients experienced 113 episodes of acute rejection (AR)after the operation, 11 recipients had no response to conventional steroid bolus treatment, the clinical data of this group of patients was analyzed retrospectively. Results Incidence rate of AR in our single center was 16.1% (96/596), among them 9.7% (11/113) were steroid-resistant. SRAR occurred averagely on 19 d (6-72 d)after liver transplantation, 3 were controlled by OKT3 treatment, 4 were reversed by IL-2 receptor inhibitors combined with MMF. Rejection could not be reversed in 4 patients and 2 finally received retransplantation. Mortality rate associated with SRAR was 36.4% (4/11) including, one from acute liver failure, 1 from chronic liver failure, 1 from renal failure after retransplantation and 1 from pulmonary infection after OKT3 treatment. Conclusion SRAR is a severe complication with high mortality after liver transplantation, OKT3 and IL-2 receptor inhibitors are effective in only a portion of these patients.