Objective To analyze the outcome of allograft function of the HBsAg(+) recipients and discuss the suitable time of antiviral therapy. Methods Twenty-one HBsAg(+) recipients were randomly divided two groups: one group (11 cases) taking lamivudine orally after recovery of intestinal function, and another group (10 cases) taking lamivudine orally when liver dysfunction and increased HBV-DNA (HBV-DNA>106 copies/L) occurred during the period of follow-up. Liver function, allograft function, and hepatitis virus reactivation were followed up for 2 years after transplantation. Results Hepatitis recurrence and liver dysfunction after renal transplantation lay in viral replication after immuno-suppression. Lamivudine therapy accomplished the goals of viral suppression, and normalization of alanine aminotransferase (ALT) levels. Preemptive lamivudine therapy for recipients had a better liver and allograft function than oral administration for patients with liver dysfunction and increased HBV-DNA copies during a period of the two-years follow-up. Conclusion HBsAg (+) is not contraindication of renal transplantation. Preemptive lamivudine therapy early after operation could avoid liver dysfunction and improve the renal allograft function during the period of two-years follow-up.

AIM: To study the clinical treatments and prognosis of the severe pneumonia in 12 patients after renal transplantation. METHODS: Twelve patients with severe pneumonia following renal transplantation treated in Guangdong Provincial Hospital of Traditional Chinese Medicine were selected between May 2004 and October 2006. They all agreed to the experiment. Seven patients had pneumonia at 3 months after transplantation, 1 at 3.5 months, 3 at 4 months and 1 at 5 months. The main therapy included immunosuppressive removal at early stage, mask oxygen inhalation, bi-level airway pressure ventilation or tracheal intubation to correct the hypoxemia; the algogen was detected by many approaches, and specific treatment was carried out according to the susceptibility test; gastroenteric nutrition was supplied through nasogastric tube, and part patients were given parenteral nutrition to strengthen nutrition support. Imaging examination of lung and blood gas analysis were performed every two to three days to evaluate the curative effect; transplanted kidney function was detected to determine the acute rejection early. RESULTS: All 12 patients were involved in the result analysis without any lost. Etiological agent detection: There were three cases with fungal pneumonia, 4 with cytomegalovirus pneumonia, 3 with bacterial pneumonia, 1 with mixed infection and 2 with unclear agent. Two cases of cytomegalovirus pneumonia developed rapidly into acute respiratory distress in 1 week after hospitalization and finally died of respiratory failure; the rest 10 patients were rescued successfully, except one with pulmonary interstital fibrosis, which could affect the life quality. CONCLUSION: The key points of successful treatment for severe pneumonia are the combination of early aggressive reduction of the immunosuppressive therapy, early detection of responsible pathogen and effective control of severe hypoxemia.

Objective:To observe the expression of nuclear factor-kappa B( NF-κB) in rats with acute lung injury ( ALI) caused by oleic acid ( OA) and investigate the protective effect of puerarin ( Pue) in ALI. Methods:Twenty-four rats were randomly divided into three groups:the control group, OA group and Pue group. Morphological changes in lung tissues were observed under a light mi-croscope and the expression of NF-κB in lung tissues were examined. Results:Morphological changes in lung tissues showed that pul-monary inflammation was relieved in Pue group compared with that in OA group. Compared with the control group, the expression of NF-κB was increased obviously in OA group (0. 39 ± 0. 07 vs 0. 12 ± 0. 04, P<0. 05), and that was decreased obviously in Pue group (0. 24 ± 0. 05), which was still higher than that in the control group (P<0. 05). Conclusion:Puerarin can alleviate the inflammation reaction in ALI through inhibiting the expression of NF-κB.

BACKGROUND:Previous studies have confirmed that healing of in vivo tendon is the outcome of interaction between endogenous healing and exogenous healing. Exogenous healing is a main reason for tendon adhesion, and affects the recovery of tendon function.OBJECTIVE: To explore application of tissue engineering technique and its materials in prevention and treatment of tendon adhesion induced by movement injury.METHODS: Using the key words of "movement injury, biomaterial, tissue engineering, tendon adhesion", we retrieved randomized animal controlled studies and clinical application literatures addressing tendon biomechanics function, adsorbable biomaterial polyglycolic acid, tendon cells-constructed tissue engineered tendon in vitro, biomembrane, chitosan, adsorbable antistick membrane, sodium hyaluronate, bioprotein gel and so on in prevention of tendon adhesion in Chinese Journal Full-text Database published from January 1990 to December 2000. By aggregate analysis of literature data, follow-up and function evaluation, this article summarized clinical application of tissue engineered techniques and materials in prevention of tendon adhesion.RESULTS AND CONCLUSION: A total of 61 literatures were primarily obtained. Following reading titles and abstracts, 31 literatures of irrelevant objectives and contents, and 9 literatures of repetitive contents were excluded. Totally 21 literatures were included for analysis. Tendon adhesion refers to hyperplasia and invasion of surrounding tissues during repair of tendon damage. With the deep understanding of tendon repair healing, application of tissue engineering to preventing tendon adhesion became more and more. Tendon healing is an interaction between endogenous healing and exogenous healing, and mainly endogenous healing, which was simultaneously associated with tendon sheath, vincula tendinum and synovial fluid. Tendon adhesion is mainly induced by excessive action of exogenous healing and damage to surrounding tissues. Tissue engineering is a novel technique. Novel biomaterials are widely used in tissue engineering performance to solve problems such as tendon injury andchondronecrosis. Presently, it Is important to reconstruct tissues, which can reach clinical outcomes of preventing adhesion.

Objective To systematically evaluate the short clinical effect of prone position ventilation (PPV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Methods All relative literatures published in the past nine years were searched by computer and hands. Quality appraisal and review data extraction of searched literatures were completed and underwent Meta analysis. Results Eight studies including 184 patients with ALI/ARDS were brought into this Meta-analysis according to the inclusion and the exclusion criteria. Oxygen in artery(PaO2) 、oxygen index (PaO2/FiO2)、pulmonary compliance (C) increased during prone position ventilation, partial pressure of dioxide in artery (PaCO2)、central venous pressure (CVP) 、peak inspiratory pressure ( PIP)、airway resistance (Raw) showed no change, heart rate (HR) and mean artery pressure (MAP) both increased. Conclusions Pulmonary compliance and hypoxemia of patients with ALI/ARDS is improved markedly in PPV. While, due to some limitations of this Meta-analysis, high quality study on PPV is still needed to make clear the clinical effect, mechanism and scientific procedure of PPV and influence of PPV on hemodynamics of patients, so that we can improve the nursing level of patients with ALI/ARDS.

Objective To explore impact of nursing intervention on the adverse reaction of patient con-trol epidural analgesia (PCEA) after abdominal operation. Methods 258 patients underwent PCEA after ab-dominal operation were selected from 2006 to 2007. The clinical data of 126 patients without nursing interven-tion were analyzed as the control group admitted to our hospital from January to December, 2006 and compared with those of 132 patients receiving nursing intervention as the experimental group from January to December, 2007. The control group was managed by the anesthetists and nurses only conducted routine nursing instruction, while the experimental group was given systematic and normative nursing intervention besides routine nursing instructions, including psychological intervention, behavioral intervention, close observation, of discovery of ad-verse reaction in time and giving early disposal. The incidence of adverse reaction of PCEA of the two groups such as urinary retention, nausea and vomiting, abdominal distension, skin indentation, catheter shedding, skin itching, numbness of lower limbs, respiratory depression was observed. Results Compared with the control group,the incidence of adverse reactions of PCEA in the experimental group such as urinary retention,nansea and vomiting, abdominal distension,skin indentation,catheter shedding was significantly lower. Conclusions The implementation of nursing intervention can reduce the adverse reaction of PCEA after abdominal operation, alle-viate the suffering of patients, and promote functional recovery and the body rehabilitation.

Objective To investigate and analyse the current situation and the factors impacting nursing soft skills in order to provide targeted advice to improve students′ nursing soft skills .Methods Totally 1 000 student nurses were investigated by the nursing soft skills scale and the self‐designed questionnaire .Results First ,there was no differences between the nursing soft skill of students and the national new nurses(P> 0 .05) .But the students′ organizational management and cognitive skills were lower than that of national new nurses(P< 0 .05) .Second ,class leader ,familiarity and fancy for nursing science were the main factors impac‐ting nursing soft skills(P< 0 .05) .Third ,the students′ organizational management and cognitive skills had an increasing trend fol‐lowing the extent of familiarity and fancy for nursing science(P< 0 .05) .Conclusion Education management institution and nursing schools should try to make some reform mearsure to improve students′ nursing soft skills .

Objective To investigate the effective endodontic irrigation protocols on smear layer removal from curved canals. Methods Forty extracted mandibular first molars with curved mesial root canal were selected and decoronat-ed. Mesiobuccal root canal was instrumented to F3 using handed ProTaper system, and randomly divided into four groups ac-cording to final irrigation protocols: syringe irrigation (group A), #30K file agitation (group B), passive ultrasonic irrigation (PUI, group C) and combination of #30K file agitation and PUI (group D). The ultrasonic file was located within 0.5 mm coro-nal from start of the curvature. All root canals were mesio-distally split, snicked at the start of the curvature and 2 mm apical-ly from the start of the curvature, and divided into three sections. They wereⅠ,ⅡandⅢfrom coronal to apical. The smear layer of each section of root canal was examined under scanning electron microscope (SEM). Results Group D presented small amounts of scattered or thin smear layers and obtained the lowest score at each section of root canal wall. At sectionⅠandⅡ, there was no significant difference in smear layer score between group D and group C. The smear layer scores were both significantly lower in group D and group C than those of group A and group B (P<0.05). At sectionⅢ, the smear layer score was significantly lower in group D than that of group A, group B and group C, and which was significantly lower in group B and group C than that of group A (P<0.05). Conclusion When ultrasonic file was located coronal from the start of the curvature, K file, which was the same size as dimension of apical portion preparation to agitate and PUI can remove smear layer from curved canals efficiently.

OBJECTIVETo raise the accuracy of clinical diagnosis of chronic hepatitis B.

METHODSThe correlation between the clinical features, biochemical tests (the serum total bilirubin-TBil, albumin-ALB, prothrobin activity-PTA, alanine aminotransferase-ALT, albumin/globulin-A/G, and r-globulin-r-G) and histopathological data in 202 patients with chronic hepatitis B (CHB) were studied.

RESULTSSome of presenting symptoms and signs were obviously associated with histological grade and stage. The grade of necroinflammatory activity of CHB was associated with the rising TBil, ALT, GGT and the declining ALB, A/G and PTA. The coincidence of clinical diagnosis and pathology was highest in mild chronic hepatitis, 63.8%~79.0%; then was in marked chronic hepatitis, 40.0%~62.5%. The coincidence was lowest in moderate chronic hepatitis, 10.0%~28.2%.

CONCLUSIONSGreat attention should be paid to the significance of symptoms and signs, meanwhile the standard of clinical diagnosis for moderate chronic hepatitis might be relaxed somewhat.

Adolescent ; Adult ; Aged ; Alanine Transaminase ; blood ; Bilirubin ; blood ; Biomarkers ; analysis ; blood ; Clinical Medicine ; Female ; Hepatitis B, Chronic ; blood ; diagnosis ; pathology ; physiopathology ; Histological Techniques ; Humans ; Male ; Middle Aged ; Prothrombin ; analysis

Objective A new field of organ donation after cardiac death (DCD) has been explored to create additional source to clinic transplantation in China.Methods A 33-years old male patient underwent permanent vegetation state for more than 2 years in ICU after severe head injury.His relatives gave writing consent to donate his organs in order to save his renal failure father and others,if possible,in case of cardiac death.On July 27,2005,the patient's heart arrested.Clinic death was announced.The case was immediately referred to transplant team and Maastricht-V DCD organ procurement was emergently performed and two kidneys were harvested. Estimated warm ischemic time was about 40 min followed by 8 h cold ischemic time.Two adults received the grafts.One of recipients was donor's biological father,namely it was the first case of deceased related renal transplantation (DRRTx) in China.Results Both recipients developed delayed graft function postoperatively and eventually recovered after few weeks.By submission of this article,the DRRTx patient has survived with normal renal function for 77 months (6 years and 5 months).Unfortunately,other patient died from fungus pneumonia after 56 months with normal renal function.Conclusion Non-controlled Maastricht-V DCD could be an additional source to transplantation if prompt reaction could be taken.