Objective To investigate the relationship between individual pharmacokinetics characteristics of cyclosporine (CsA) and the occurrence of acute rejection episodes or CsA-induced nephrotoxicities in kidney transplants. Methods The whole blood CsA concentrations were assayed 7 days after oral admi- nistration with a dosage of 6 mg/kg daily in 47 recipients. The blood samples drawn just prior to ingestion of the dose and subsequently at 1, 2, 3, 4, 5, 6, 8, 10, 12 h later were monitored with TDX. Recipients were grouped according to the varied situations of kidney transplant functions within one month after pharmacokinetics monitoring. Pharmacokinetics parameters of C_0, C_ max , T_ max , CL/F, T_ 1/2(a) , T_ 1/2(e) and AUC in each group were calculated and compared among the groups. Results Of 47 recipients, 12 cases had experienced AR episodes, 7 cases had suffered CsA-NT, and the remaining 26 cases survived with stable graft functions. Major pharmacokinetics parameters in AR group were T_ 1/2(a) , T_ 1/2(e) , CL/F, T_ max and AUC, which were significantly different from the corresponding parameters in the group with stable graft function. Pharmacokinetics curve of AR group was characterized with a earlier T_ max (usually less than 2 h), a sharp absorb peak and a abbreviated AUC, T_ 1/2(e) , CL/F, T_ max , and AUC in CsA-NT group, which was also significantly varied from that in the stable group. The curve of CsA-NT group, with a delayed T_ max (often more than 2 h), a broad absorb peak or double peaks, however, was predominantly distinguished from the previous AR curve. Levels of C_0 in the three groups were comparable when AR or CsA-NT occurred. Conclusion Pharmacokinetics monitoring accomplished by multiple point CsA level samples over the entire 12 h dosing interval is a more accurate assessment for drug exposure. It is suggested that patients who absorb and eliminate CsA quickly are likely to experience AR episodes. Meanwhile, those poor eliminators are at risk to suffer CsA-NT.

Objective To investigate technique,effect,complications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula.Methods Between November 1998 and February 2010,32 patients with malignant tumors of the proximal tibia involving the fibula underwent limb salvage surgery in our institute.There were 21 males and 11 females,aged from 10 to 66 years (average,23.4years).There were 23 cases of osteosarcoma,5 cases of chondrosarcoma,1 case of malignant giant cell tumor,and 3 cases of soft tissue sarcoma.All patients received en bloc resection of tumor including proximal tibia and fibula.During operations,ligation of anterior tibial vessels was performed in 14 patients,anastomosis of posterior tibial vessels in 1 patient,both ligation of anterior tibial vessels and anastomosis or replacement of posterior tibial vessels in 5 patients.The common peroneal nerve was resected in 4 patients,and the deep peroneal nerve was resected in 5 patients.The reconstruction methods included prosthetic replacement in 24 patients,replacement with inactivated autograft-prosthesis composite in 5 patients,and replacement with inactivated autograft in 3 patients.The caput mediale musculi gastrocnemii flap was transferred to reconstruct soft tissue defect in 14 patients,while caput laterale musculi gastrocnemii flap was transferred in 1patient.Results All patients were followed up for 11 to 159 months (average,39.4 months).Local recurrence occurred in 6 patients (18.8％).The overall 5-year survival rate was 51.2％.Fourteen patients died of tumor metastasis,2 survived with tumor,and 16 patients survived without tumor.Variant complications occurred in 15 patients (46.9％).The complications included ischemia of the lower leg in 4 patients,peroneal nerve palsy in 12 patients (permanent palsy in 9 patients and temporary palsy in 3 patients),wound healing problem in 4 patients,deep infection in 1 patient,and periprosthetic fracture in 1 patient.The mean MSTS 93 score was 21.6 points (72％).Conculusion The indications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula should be restricted.Although complications are encountered frequently,most patients have acceptable postoperative function.

ObjectiveTo observe the clinical efficacy of moxibustion plus acupoint autohemotherapy in treating allergic rhinitis due to lung-spleen qi deficiency.MethodTotally 120 eligible subjects were divided by using the random number table into a comprehensive group, a moxibustion group and a Western medication group. The comprehensive group was intervened by moxibustion plus acupoint autohemotherapy, the moxibustion group was by moxibustion,and the Western medication group was by Loratadine tablets. The acupoint autohemotherapy was give twice a week and the rest treatments were given once a day, 7 das a course, for 4 courses in total. A follow-up study was conducted 3 months later. The clinic efficacy was evaluated before and after intervention, as well as in the follow-up study.ResultThe three groups all achieved significant short-term efficacies after intervention, and the comprehensive group was equivalent to the moxibustion group, bothsuperior to the Western medication group(P<0.05). According to the follow-up study, the long-term efficacies of the comprehensive group and moxibustion group were both significantly higher than that of the Western medication group (P<0.01,P<0.05), and the moxibustion group was superior to the comprehensive group in comparing the long-term efficacy (P<0.01).ConclusionMoxibustion plus acupoint autohemotherapy and dry moxibustion both can produce significant short-term and long-term therapeutic efficacies in treating allergic rhinitis due to lung-spleen qi deficiency. The long-term efficacy of moxibustion is higher than that of moxibustion plus acupoint autohemotherapy in treating allergic rhinitis due to lung-spleen qi deficiency. Acupoint autohemotherapy requires strict aseptic operation, which restricts its application in family healthcare. Long-term use of moxibustion can activate yang qi, and thus plays a role in preventing diseases.

Background and purpose: Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm characterized by slow growth and indolent behavior, and most of the patients had metastases in diagnoses. This study was to define clinical features and assess prognostic factors of ASTS. Methods: Between January 2003 and December 2008, there were 15 patients with ASTS who received treatment and were followed up in the Department of Orthopedic Ontology of Peking University People's Hospital. We retrospectively analyzed the clinical factors of the disease related to prognosis: gender, age, tumor size, primary tumor site, metastatic sites, local recurrence, the roles of postoperative radiotherapy and postoperative chemotherapy. Resnlts: At a follow-up from 7 to 76 months, only 2 patients had local recurrences after excision, but there was a high incidence of pulmonary metastases. Only 6 patients achieved disease free survival, 5 patients died of metastases or other complications. The five-year overall survival rates was 41.7%, and the median survival time was 42.0 months. Univariate analysis and Cox regression analysis revealed that tumor size, tumor primary site and metastases at diagnoses were prognostic factors, but not gender and age, Conclusion: Alveolar soft part sarcoma is a high grade malignant soft tissue neoplasm with frequent metastases to lung, bone or brain. Tumor size, primary tumor site and metastases at diagnoses are some of the prognostic factors. Chemotherapy or radiotherapy after surgery have no benefit to the survival in our analysis. Further prospective studies are needed to clarify the best strategy for the treatment of ASPS.

BJECTIVE: To explore the effect of different convergent conditions on accuracy of simulation results from a three dimensional finite element model of the pelvic ring.METHODS: A first-order linear load of 600 was applied on the S_1 vertebral endplate in an established three-dimensional finite element model. The step length was set to 0.1 s. The boundary condition was set as constraint of 6 degrees of freedom in the proximal femur. Static and dynamic explicit convergences with 6 different weight scale factors were calculated retrospectively,and all the simulated results were compared with the experimental results in order to verify the accuracy. RESULTS: The static convergence predicted most accurate with the linear regression coefficient 0.88. With the increase of weight scale factor, the time cost decreased. However, the accuracy of the predicted results decreased. There was statistically difference between the simulation results and experimental results when the weight scale factor achieved 3 000 (P<0.05) and the coefficient of linear regression was lower than 0.8.CONCLUSION: It suggested that as for the complex finite element model, especially when the model contains complex contact conditions, dynamic explicit convergence can be an alternative solution to static convergence if the latter failed. Also proper weight scale factor should be used to decrease the time cost under the condition that the error was in the limited.

BACKGROUND: Many methods involved in measuring energy expenditure of physical action, however, study regarding measurements of upper limber movement energy expenditure are few.OBJECTIVIE: To measure the energy expenditure of limber movement using indirect calorimetry, and to analyze the characteristics of upper limber movement energy expenditure and influencing factors such as age and gender.DESIGN, TIME AND SETTING: The comparison observation was performed at the Jiangsu Institute of Sports Science from January to March 2009.PARTICIPANTS: Totally 108 health adults, including 47 males and 61 females, participated in the study, 65 of them aged 20-39 years, and the remained 43 aged 40-59 years.METHODS: Energy expenditure of 4 upper limb movements were performed, including sitting posture arm swing (60 times/min),elbow flexion (40 times/min), shoulder flexion-extension (60 times/min), and lateral arm raise (30 times/min). At each interval,have a 3-minute rest.MAIN OUTCOME MEASURES: Oxygen expenditure of 4 kinds upper limb movements were measured by MetaMax 3B tester. RESULTS: Rest oxygen expenditure of males were greater than that of females (P < 0.05), greater in 20-39 years old than 40-59 years old (P < 0.05). The greatest oxygen consumption occurred in males with arm swing [(550.9±90.6) mL/min], which was (425.8±75.7) mL/min in females. The lowest oxygen expenditure was elbow bend [male: (440.4±82.7) mL/min, female: (367.0±60.1) mL/min]. Net oxygen expenditure of all 4 kinds of upper limb movements was lower than 250mL/min (1 metabolic equivalent).CONCLUSION: ① The energy expenditure of usual upper limber movements below 1 metabolic equivalent. ② Age and body mass has more effect on resting energy expenditure than the gender. ③ The efficiency of young adults upper limb movements is higher than old adults.

Objective To assess the immune protective effect of donor spleen perfusion on the renal allografts in specific sensitized canine recipients.Methods Male dogs were operated as donors and recipients for kidney transplantation.Eighteen dogs were previously sensitized by a method of multi-infusion of small number of lymphocytes from a paired donor and were then randomly divided into 3 groups equally.In donor specific spleen perfusion group,the artery and vein of the excised do- nor canine spleen were connected to the abdominal aortic artery and inferior vena cava of the recipient with processed fistula tubes,perfused at a speed of 18-25 ml/min for 40 min and then kidney from the same donor was transplanted to the recipient;In non-specific spleen perfusion group,the methods of excised spleen perfusion and kidney transplantation were indifferent to the above group except for the organs which removed from a non-specific donor;In control group,kidney transplantations were per- formed after an exclusion time of 40 min in the open abdominal surgery.Cross-match between paired dogs monitored by means of complement dependent cytotoxicity(CDC)and mixed lymphocyte culture (MLC)test before and after donor spleen perfusion was investigated.Rejection episodes and serum creatinine level in each group were assessed after kidney transplantation.Results Immune sensitization was successfully induced in all 3 groups after 3 to 4 times of donor lymphocyte stimulations.CDC as well as lymphocytes proliferation in MLC and CH50 of recipients was significantly declined after spe- cific spleen perfusion,and white blood cell count in peripheral blood also decreased transiently.After kidney transplantation between the paired sensitized dogs,the advanced rate of renal allograft function deterioration was slower in specific spleen perfusion group than in other two groups.The pathologic investigation suggested that severity of rejection in spleen perfusion group was milder than in other two groups.Conclusions Donor spleen perfusion can present a specific absorption efficacy for pre- formed antibodies and activated lymphocytes in sensitized recipients,as well as simultaneously deplete part of platelets in peripheral blood.So donor spleen perfusion may delay the presenting time of rejec- tion in early phase after kidney transplantation between the paired sensitized dogs,ameliorate the se- verity of rejection so as to improve the renal allograft function.

Objective: To determine the prognostic factors of primary osteosarcoma in adults . Methods:This is a review of 54 patients older than 40 years (24 men and 30 women) who were treated between 1998 and 2011 at the authors ’ institution .Demographic information and follow-up data were obtained and statistically analyzed .Results: Tumors involved the limbs in 30 patients ( 55 .5%) and axial skeleton in 17 patients (31.5%), and arose from soft tissue in 7 patients (13%).And 6 patients (11.1%) had synchronous metastasis .According to our review , tumors were treated surgically in 52 patients (96.3%).Local recurrence was documented in 14 patients (26.9%).Metastasis after diagno-sis appeared in 21 patients (38.9%).In the 52 patients who received the surgical treatment , the 5 year disease-free survival and overall survival rates were 43.7% and 50.4%, respectively.Conclusion:Adult patients with primary osteosarcoma had a poor clinical outcome .Inadequate surgical margins , more tumors in the axial location due to high recurrence rates , metastatic disease at presentation , and large tumor volumes were associated with significantly lower survival rates .Aggressive multi-agent treatment regimens might improve survival .

Objective To investigate the application and clinical effect of uncut Roux-en-Y (uncut RY) anastomosis in laparoscopic distal radical gastrectomy of gastric cancer.Methods The retrospective crosssectional study was adopted.The clinical data of 23 patients with gastric cancer who were admitted to the Northern Jiangsu People's Hospital from December 2014 to July 2015 were collected.All the 23 patients underwent laparoscopy-assisted distal gastrectomy (LADG) and total laparoscopic distal gastrectomy (TLDG) according to the individual situations.The indexes of observation were collected,including (1) intraoperative indexes:operation time,uncut RY anastomosis time and volume of inraoperative blood loss,(2) postoperative indexes:time to anal exsufflation,time for initial water intake,time for semi-fluid diet intake,time for out-off-bed activity,duration of hospital stay,occurrence of complications and results of pathological examination,(3) results of follow-up.The follow-up was performed by outpatient examination and telephone interview up to November 2015,including postoperative discomfort after diet intake,barium meal examination of gastrointestinal tract at postoperative month 1 (anas-tomotic stenosis,recanalization and dehiscence of occlusion),detecting situations of gastric remnant and anas-tomotic stoma at postoperative month 3 by gastroscopy and occurrence of gastrointestinal obstruction.Measurement data with normal distribution were presented as x ± s.Results (1) Intraoperative situations:all the 23 patients underwent successful uncut RY anastomosis,including 18 receiving LADG and 5 receiving TLDG.The operation time,uncut RY anastomosis time and volume of intraoperative blood loss were (165.9 ± 11.6) minutes,(18.2 ± 2.2) minutes,(48 ± 6) mL in all the 23 patients and (172.0 ± 8.5) minutes,(26.6 ± 1.5) minutes,(46 ± 4) mL in 5 patients with TLDG,respectively.Two patients received hemostatic treatment using suture and hemostatic forceps due to anastomotic bleeding.(2) Postoperative situations:time to anal exsufflation,time for initial water intake,time for semi-fluid diet intake,time for out-off-bed activity,duration of hospital stay and incidence of complications in all the 23 patients were (2.2 ± 0.4) days,(2.7 ± 0.4) days,(3.5 ± 0.4) days,(2.7 ± 0.3) days,(10.6 ± 1.4) days and 8.7％ (2/23),respectively.No patient was dead in the perioperative period.Two patients complicated with incisional infection and high fever were cured by symptomatic treatment,without occurrence of anastomotic leakage,bleeding and anastomotic-related complications.All the patients received postoperative barium meal examination of upper gastrointestinal tract,with unblocked anastomotic stoma and without leakage of barium meal.Diameter of tumor and number of lymph node dissected were (3.2 ± 1.2) cm and 30 ± 4,with negative upper and lower resection margins.Numbers of patients with tumor differentiation,T stage,N stage and TNM stage were 12 and 11 in differentiated and undifferentiated tumors,1,9 and 13 in T1,T2 and T3 stages,9,11 and 3 in N0,N1and N2 stages,1,4,9,6 and 3 in Ⅰ a,Ⅰ b,Ⅱ,Ⅲ a and Ⅲ b stages,respectively.(3) All the 23 patients were followed up by outpatient examination for 3-11 months.One patient had discomfort in upper abdomen with vomiting at postoperative week 3,and no anastomotic leakage,bleeding and anastomotic-related complications were occurred in other patients.Conclusion As a modified anastomotic method,uncut RY anastomosis is safe and feasible,and it is also an ideal method of digestive tract reconstruction after laparoscopic distal radical gastrectomy.

Objective To evaluate and compare the value of predicting diseases such as hypertension and arteriosclerosis of the body mass index(BMI) and percent body fat(PBF),so as to provide the basis for evaluation of obesity.Methods Totally 3149 common residents in Jiangsu province were surveyed using the method of stratified and cluster sampling.Effective data included height,weight,PBF,blood pressure and brachial-ankle pulse wave velocity(baPWV).Obesity was defined by percent body fat with the evaluation of WHO and ASBP.Areas under ROC curves(AUC)of BMI and PBF were estimated by the nonparametric test and then the two diagnostic tests were compared by predictive value of related diseases.Results(1)Predictive value of BMI to diagnose obesity(defined by PBF):AUC are respectively 0.949(for WHO standard)、0.906(for ASBP standard)in women and 0.864 in men.In age group,the 20-39 years have the highest AUC of BMI to predict obesity.P＜0.01 for above nonparametric tests.(2)According to ROC curves we got the adjusted cut-off points of BMI are respectively 26 kg/m2 in men and 25 kg/m2 in women for WHO standard or 26 kg/m2 in men and 23 kg/m2 in women for ASBP standard,while the specificity of predicting obesity decreased from 90％ ～ 99％ to 76％ ～87％,but the sensitivity significant increased from 17％ ～ 43％ to 78％ ～ 89％;After adjusting the cutoff points of BMI,the value of kappa of prevalence of obesity increased from 0.475 to 0.537 in men and 0.115 to 0.655 in women.(3)To predict hypertension,areas of BMI were 0.688(95％CI:0.656-0.720) in men and 0.745 (95％CI:0.708-0.782) in women,similarly,of PBF were 0.687 (95％CI:0.655-0.718) in men and 0.723(95％CI:0.681-0.764)in women;To predict arteriosclerosis there showed highly consistency that the areas of BMI were 0.613(0.586-0.641)in men and 0.692(95％CI:0.659-0.726)in women,meanwhile,for PBF they were 0.635 (95％CI:0.608-0.663) in men and 0.683 (95％CI:0.648-0.718) in women (P＜0.01).(4) Paired test of the two areas under ROC curves showed that PBF had higher diagnostic value than BMI in men to predict arteriosclerosis(u=2.05,P＜0.05),however,no statistical difference in women(u=0.75,P＞0.05)and in predicting hypertension(u=0.75 to men and u=1.26 to women,P＞ 0.05).Conclusions Using BMI and PBF can all predict hypertension and arteriosclerosis effectively,thus,obesity can be evaluated suitably by both BMI and PBF in large-scale population study,especially in women and youth.Relatively,WHO standard of PBF is more suitable for Chinese population to evaluate obesity than ASBP standard.