Objective To evaluate the effect of nasal continuous positive airway pressure (nCPAP) in pediatric patients with respiratory failure after liver transplantation.Method A prospective? randomized controlled clinical trial was conducted during June 1st 2013 to June lst2015 in 71 pediatric patients with respiratory failure after liver transplantation.A total of 66 patients completed the trial and 5 patients quitted.Conventional oxygen therapy group included 35 cases and nCPAP group included 31 cases.The vital sign,blood-gas analysis,intra-abdominal pressure and prognosis were compared between the two groups.Result After nCPAP treatment,the heart rate,respiratory rate,and PCO2 decreased at 4 and 24 h (P＜0.05),oxygenation index was improved at 24 and 48 h (P＜0.05),and intra-abdominal pressure decreased at 48 h (P＜0.05).nCPAP showed better outcome than conventional oxygen therapy (P＜0.05).The incidence of refractory atelectasis,intra-abdominal hypertension,and epilepsy was higher in treatment failure population.Conclusion nCPAP is more suitable for pediatric patients with respiratory failure after liver transplantation,especially for those accompanied with intra-abdominal hypertension.

Objective To analyze the clinical feature,pathogenesis and treatment of autoimmune hemolytic anemia (AIHA) in patients after orthotopic liver transplantation.Method A retrospective analysis was conducted on 7 patients who developed AHA after orthotopic liver transplantation.The clinical feature,pathogenesis and treatment of AIHA were reviewed.Result The incidence of AIHA was 0.98％ (7/713).AIHA occurred (7.9-± 4.0) (3-14) days after transplantation.All patients were characterized by progressive anemia and jaundice.Laboratory examination showed lower hemoglobin and platelet count,higher lactate dehydrogenase,higher indirect bilirubin and higher reticuloeyte count.The causes of AIHA included ABO-incompatible liver transplantation,infection and repeated transfusion.Conclusion AIHA is a rare and serious complication after liver transplantation.The most cause is ABO-incompatible liver transplantation.The patients can be successfully cured if the diagnosis is clarified and the treatment is definitive.

Objective To investigate the potential role of tumor necrosis factor-alpha (TNF-?) in apoptosis after combined liver and kidney transplantation in rats. Methods Eighty rats which had combined liver and kidney transplantation were randomly paired, were divided into study group (n=20) and control group (n=20). 40 ml of 4 ℃ sodium chloride and anti-TNF-? monoclonal antibody (30 ml was infused from portal veins to donated livers and 10 ml from renal arteries to donated kidneys) were infused to the study group (0.1 mg/kg weight),and the same quantity of 4 ℃ sodium chloride was infused the control group. Venous blood was drew at different phases after the transplantations to detect the function of kidney and liver. The level of TNF-? and the cell apoptosis were detected in the transplanted tissues of liver and kidney by ELISA and terminal deoxynucleotidy transferase mediated dTUP-biotin nick-end labeling (TUNEL). Results The levels of AST, ACT, Cr and BUN in the study group were significantly lower than those of the control group at the same phases (P

The diagnostic criteria of diabetes has been changed several times in the latest thirty years.The diagnostic criteria is based on plenty of epidemic studies,especially the relationship between the glucose level and the microvascular complications.However,there are many problems in the clinical practice of using the recent diagnostic criteria(1999 WHO criteria).Glycosylated hemoglobin(HbA1c) has been recommended as a diagnostic criteria in the 69th ADA.

Objective To provide a clinical method in the treatment of patellar ligament defect. Methods Based on morphologic observation and blood supply of the medial tenden of gastrocnemius muscle on 30 adult cadaverous lower limp specimens. Then transferring of sural arteries medial tendon of gastrocnemins muscle was designed and used in 4 patients clinically. Results The period of follow-up in all cases was 2-8 months. The knee joint recovered well with satisfactory function. Conclusion The operation is a simple and ideal procedure. The vascularizod adductor magnus tendon is a good donor in the reconstruction of patellar ligament defect. Microsurgical repair of patellar ligament defect is a effective method.

Objective:To study the effect of phillyrin on immune function in mice treated with cyclophosphamide.Methods: Mice model of immunosuppression was induced by intraperitoneal injection of cyclophosphamide,the mice in the experimental group received phillyrin with 50,100 and 150 mg/kg doses by gavage.While model group and control group received normal salin,all treatments continued 7 d.The thymus and spleen organ coefficients was measured by conventional methods.The phagocytosis of peritoneal macrophages was measured by FITC microspheres.The levels of IL-2,IL-4 and cAMP in peripheral blood were detected by ELISA.The effects of different doses of phillyrin on the above indexes were analyzed in immunosuppressed mice.Results: A mice model of immunosuppression was established after 7 d,the results showed that the immune organ index,phagocytic capacity of macrophages and the level of immune factors in serum could be improved,and the content of cAMP in peripheral blood lymphocytes was decreased in different degree by phillyrin.Conclusion: Phillyrin has the function of immune regulation,which can resist the immunosuppression of cyclophosphamide.

0.05). In group B,the serum creatinine levels of cases treated with ulinastatin at 1,3,7,10 and 14 days after renal transplantation were (372.6? 128.1 ),(278.4?38.9),(145.9? 47.2 ),(133.2?39.8),(128.0?30.6)?mol/L,respectively;the values of controls were (496.3?125.6),(364.7?60.2),(196.2?36.8),(161.4?41.5),(149.8? 33.5 )?mol/L,respectively ( P

Objective To investigate the dynamic expression and clinical significance of toll-like receptor 4(TLR4)/CD80 in patients before and early after renal transplantation. Methods Thirty-two patients who received renal transplantation were enrolled in his study. All of them were primary recipients, and the level of panal reactive antibody less than 1%. The expression of TLR4 and CD80 in CD14, positive monocyte of peripheral blood from atients on the 1st, 4th, 7th, 14th, 21st, 28th and 35 th days after transplantation were measured by three-color fluorescent taining flow cytometry. The pa-tients were divided into rejection roup(7 cases) and non-rejection group(25 cases) according to rejec-tion episode record within 2 weeks. Normal control group(10 cases) enrolled healthy adult volunteers. Diagnosis of acute rejection depended on clinical symptoms, lab test, color doppler onography and re-nal biopsy. Results Before ransplanstation, the ressions of TLR4 and CD80 were (8.03± 0.84)% and (0.85±0.31)% in rejection group, (6.14±0.85)% and (0.84±0.39)% in non-rejec-tion group, (6.37±0.56)% and (0.85±0.35)% in normal control group. The expression of TLR4 of rejection group was higher than those of non-rejection group and normal control group(P<0.01). The expressions of CD80 of 3 groups had no significant difference(P=0.995). After ransplanstation, the expressions of TLR4 and CD80 increased to (16.50±1.02)% and (7.82±1.66)% in rejection group, (11.60±0.98)% and (2.26±0.96)% in non-rejection group at the 4th day, and reached the peak levels at the 7th day: (36.40±4.86)% and (9.53±1.97)% in rejection group, (22.70± 3.45)% and (1.87±0.72)% in non-rejection group, then displayed downtrend, rejection group de-creased to (7.10±0.82)% and (0.87±0.57)% at the 35th day, non-rejection group decreased to (7.20±0.76)% and (0.81±0.37)% at the 21st day. Compared with non-rejection group, rejection group showed higher peak expression value of TLR4/CD80 (P<0.01) and longer lasting time. Con-clusions The high expression of TLR4 may increase the risk of acute rejection. The up-regulated TLR4/CD80 levels early after renal transplantation may ontribute to the happeness of acute rejection.

Objective To observe and analyze the reasons of intra-abdominal hypertension,and to discuss the influence of intra-abdominal hypertension (IAH) on recipients' respiratory function and its changes after disposition.Method During January to June in 2012,50 patients who had performed orthotopic liver transplantation were involved in this study.Intra-abdominal pressure was measured by AbViser Intra-Abdominal Pressure Monitoring Kit.According to the value of intra-abdominal pressure,the patients were divided into two groups (IAH group and control group).The reasons of IAH were observed and analyzed.Respiratory rate,oxygenation index,and the arterial partial pressure of carbon dioxide between IAH and control groups were compared.IAH was dealt with restricting oral input,inserting nasogastric tube,administering enema,inserting ilues tube or placing percutaneous catheter drainage according to reasons.Intra-abdominal pressure,respiratory rate,oxygenation index,and arterial partial pressure of carbon dioxide were also observed after disposition.Result The incidence of IAH was 44％ (22/50).The respiratory rate of patients in IAH group was quicker than that in control group.The oxygenation index in IAH group was lower than that in control group.The arterial partial pressure of carbon dioxide in IAH grade I group was not higher than in control group.However,the arterial partial pressure of carbon dioxide in IAH grade Ⅱ and Ⅲ groups was higher than in control group.After disposition,the intra-abdominal pressure,respiratory rate and arterial partial pressure of carbon dioxide in IAH groups were decreased from 16.4 ± 3.1 mmHg,33.0 ± 5.2 L/min and 47.6 ± 9.4 mmHg to 10.5 ± 1.8 mrnHg,19.7 ± 4.1 L/min and 39.9 ± 2.9 mmHg respectively,while the oxygenation index was increased from 202.7 ± 72.9 mmHg to 350.5 ± 98.5 mmHg.Conclusion The incidence of IAH after orthotopic liver transplantation was high.The influence of IAH on patients' respiratory function was serious.After timely and proper disposition,the respiratory function of patients with IAH could be improved.

Objective To carry out a pharmacokinetic evaluation of oral FK506 in 13 patients after renal transplant. Methods 13 patients after renal transplantation were given prograf based immunosupressive regimen 24 hours after surgery.Blood samples to determine FK506 levels were drawn in heparinized tube at 0、20、40、60、90 min and 2、3、6、8、10 hours after the first oral dosing.The whole blood concentrations were measured by MEIA and the pharmacokinetic parameters were calculated by 3P87 program.The FK506 doses were recorded in detail for the first month. Results Cmax was (13.6259?4.1117)ng/ml;T(peak) was (1.4866?1.0725)h;t1/2 ? was (0.7749?0.7791)h,t1/2 ? was (10.7267?10.4926)h;AUC was (91.0415?40.7694)ng?ml -1 ?h -1 ,CL was (0.046?0.0036)ng?ml -1 ?h -1 and MRT was (8.1540?4.2937)h.AUC was negative correlateld with prograf dose in the first month posttransplant (r=-0.53, P =0.038). Conclusions The absorption of oral administration of FK506 was rapid in patients after renal transplantation,and can achieve Cmax in (1.5?1.1)h,the mean half life time being 10.7 h.The pharmacokinetic parameters can be the guideline for FK506 application.