Under active exploration and practice of several generations of organ transpant workers,organ transplantation in China has developed rapidly since 2000 and achieved remarkble results.Techniques of transplantation become mature,and liver transplantation and renal transplantation have reached international advanced level,which benefit massive patients.With high attention and promotion of national government and health administrative departments,structural changes have occurred to source of national organ transplantation to form a China Model.The donation after citizen's death has become the new normal in the organ transplantation in China.Human organ donation work promots the rapid development of transplantation in China,but it also faces challenges of the donor organ shortage and quality improvement.Under the new situation,health,family planning and medical reform work of the national13th Five Year Plan puts forward new requirements on human organ donation and transplantation.Combined with practical work,this article gives a few opinions on how to scientifically further improve the quality and quantity of organ donation and transplantation and directions of future works.

Objective To investigate the effects of clod plasma cardioplegia on the function and structure of immature myocardium. Methods Thirty-two new Zealand white rabbits of 17-26 days weighing (512 ?56) g were anesthetized and heparinized. Their hearts were excised and perfused in a Langendorff apparatus with warm (37℃) oxygenated (95%O2, 5%CO2) Krebs-Henseleit buffer(KHB) at 60 cm H2O perfusion pressure. After the isolated heart had been beating regularly for 10 min, the heart was perfused with clod (10℃) St. Thomas cardioplegic solution (group C, n = 16) or cold cardioplegic solution mixed with plasma (St. Thomas solution: plasma = 1:4) (group P, n=16). The K+ concentration of the cardioplegic solution in both groups was the same. After 30 min cardiac arrest the heart was again perfused with KHB. The following observations were made: (1) the interval from the beginning of cardioplegic solution infusion to cardiac arrest and the amount of cardioplegic solution used; (2) the duration from KHB reperfusion after 30 min cardiac arrest to the recovery of regular heart beat; (3) heat rate after recovery from cardioplegia; (4) coronary flow; (5 ) myocardial water content; (6) myocardial structural changes shown by microscopic examination. Results (1) There was no significant difference in the time needed to induce cardiac arrest and for recovery of regular heart beat from cardioplegia. (2) The heart rate was (129 ?5)beat/min in group P and (120?) beat/min in group C, the coronary flow was (5.10?0.20) ml?L-1 in group P and (3 50? 0.50) mi ?L -1 in group C, the differences were statistically significant (P

To explore the value of two dimensional ultrasonography used in gunshot wound, features of gunshot wound in pig thigh were studied by high frequency ultrasound and compared with pathologic examination. The primary wound tract showed remarkable features in ultrasonography with a cured anomalous pipelike image, which changed with time. Tissues around the wound tract also revealed some sonographic characteristics. The results indicate that two dimensional ultrasound can clearly manifest not only the shape and distribution of the wound tract, but also the relation between the tract and its adjacent tissues. Therefore, the method is of important value in treatment of gunshot wound.

Since the current worldwide medical education and clinical practice lay a particular stress on training medical students with scientific knowledge and medical technical skills,enormous medical staffs are shaped into medical technical workers who lack medical morality and emotions,leading to the contradiction between medical morality and technologies.Medical personnel should know that medicine not only observes illness closely,but also attaches importance to the patients themselves who are suffering the pain.Medical students should pay attention to the forming process of medical morality and emotion in their preparative stage,accept the exercise to prepare for medical morality,and recalls their love and concern for life.

Hepatic fibrosis in rat induced by intraperitoneal injection of dimethylnitroamine (DMN) was traeted by RNA (4 mg ? kg-1) and CoQ10(2. 5 mg ? kg-1) ,seperately. Normal and pathological groups were compared. In 30, 60 and 90 days treatment, rats were killed for ul-trastructural examination and measurement of serum enzymology, serum amino acids and the quantity of collagenous fibers. The results indicated that, in RNA-treated and CoQ10 treated groups, Aspartate aminotransferase (AST) and Y-glutamyl-transpeptidase(?-GT) were normal, the ratio of albunm to globulin (A/G) had significantly difference compared with controlgroup. In RNA-treated group,L-Alanine:2-Ox-oglutarate Aminotransferase(ALT), monoamine oxidase (MAO) and N-acetyl-?-glucosaminidase (NAG) decreased evidently, serum amino acids increased slightly. Ultrastructural and microscopical examination showed the degree of hepa-tocytic necrosis degeneration and the quantity of collagenous fibers in RNA-treated group were rather mild. It appeared that there were protection effects of RNA on liver enzymology and hepaticfibrosis.

The development of medical technology draws the doctor-patient relationship ever closer.However,the abundance and complexity of medical knowledge and technology make it a difficult task for medical personnel to grasp medical knowledge and skills,setting up a higher request for handling physician-patient relationship.Besides,medical disputes between doctors and patients caused by the abuse of medical technology in clinical practice also contribute to the contradiction between the advancement of medical technology and the latency of medical morality.Therefore,it is one important part in the study on medical morality from the perspective of medical technology ethics to take a rational view on the development of medical technology and construct a harmonious physician-patient relationship.

Objective To summarize the result of several kinds of flaps treated to first web space contraction. Methods Thirty-two cases of sever contracture of the first web space were treated between September 2000 and March 2009. Ultrathin groin flap, blood vessel pedicle reverse-flow island flap, neurocutaneous flap of the forearm, and free skin flap were used. The area of flaps were 3.0 cm × 5.0 cm-4.5 cm× 8.0 cm.The therapeutic result was observed by 3-12 months follow-up. Results There were partial necrosis at the distal part of flap in 1 case of nerve nutritional vascular pedicle skin flap and 1 case of ultrathin groin flap.The raw surface was healed by free skin grafting. The other flaps were all survived. There was some contraction observed in some patients after the K-wire released. The width of the first web space was augmented to an average of 50 mm (35-60 mm) and account to 80% to the uninjured side. The angle of the first web space was increased to an average of 70°(45°-80°). The contracture was improved significantly. The abduction and opposition function of thumb were restored. There was some degree decrease of grasp strength. The patients can fulfil daily life and partial work. But sensation was not good in some patients. The contour of the flaps:the contour of ultrathin groin flap was good. The contour of flaps in 3 cases of island skin flaps, 1 case of nerve nutritional vascular pedicle skin flap and 2 cases of free flaps were trimmed again in order to be improved. Conclusion The sever contracture of the first web space could be treated by different kinds of flaps, the suitable management should be chosen according to the specific situation.

Objective To explore the value of two dimensional and color Doppler flow imaging(2D CDFI)for the diagnosis and differentiation of the carotid body tumor.Methods Retrospective analysis was made on 12 patients with carotid body tumor examined by 2D CDFI,and differentiations were conducted between several similar diseases.All the cases were confirmed by surgical pathology.Results The carotid body tumor in 2D CDFI was shown as follows: Low echoic substantial masses were found in the carotid branch with clearly boundary,and or partly outline.Most in small size were located at the branch of common carotid artery,so the interval between external and internal carotid arteries was enlarged.The masses in big size always grew around common cartid artery internal carotid artery and external carotid artery.More color flow signals were detected in the masses,and most were artery flow.The relationship between the mass and the carotid was shown clearly by 2D CDFI.Conclusions 2D CDFI is a valuable and practical method in diagnosis of carotid body tumors.

Objective To examine the effect of valproic acid (VPA) on concentration of Intracellular Ca2+ and on cell apoptosis in spinal cord motor neurons after brachial plexus injury in rats. Methods Totally 210 adult male Wistar rats were randomly divided into Sham operation group (disposed the brachial plexus nerve root, but not cutted it off), control group (rats with brachial plexus nerve root amputating wound)and VPA group(rats with brachial plexus nerve root amputating wound and fed by VPA water),with 70 rats in each group.The specimens were taken at 12,24,48,72 h,1,2 and 4 weeks after operation.Whole-cell patch-clamp recording techniques were used to assayed the L-type calcium channel of motoneuron and monitored the changes in intracellular concentration of Ca2+ with spectrofluorometer. The motoneruron apoptosis was detected by TUNEL. Results The set of indicators did not change in the sham group.From 12h to 1 weeks after the operation, the electrical current of L-type calcium channel and the intra-cellular Ca2+ concentration of the neuron were obviously more in control group than in sham operation group (P ＜0.05). From 12 h to 4 weeks after the injury, there were more apoptosis neurons in control group than in sham operation group (P ＜ 0.05). There was no obviously difference in electrical current of L-type calcium channel between the VPA group and the control group at each time point(P ＞ 0.05).Compared to the control group,the intra-cellular Ca2+ concentration was lower in VPA group from 48 h to 1 week after nerve injury (P ＜ 0.05) ; the number of apoptosis neurons were less in VPA group from 24 h to 2 weeks after the injury (P ＜ 0.05). Conclusions Brachial plexus nerve root amputating wound in rats can increase the intra-cellular Ca2+ concentration and apoptosis of the motor neuron.VPA can reduce the intra-cellular Ca2+ concentration and apoptosis,but has no effect on the L-type calcium channel of the motor neuron.

Objective To investigate the risk factors of chylous leakage after pancreatioduodenectomy so as to find effective measures to prevent this complication.Methods A retrospective analysis was conducted on 230 patients who underwent pancreatioduodenectomy at the First Affiliated Hospital of Zhejiang University from Jun.2012 to Jun.2014.Patients with chylous leakage were identified and a 1 ∶ 2 patients in the study and the control groups were selected.The parameters for matching included tumor volume,vascular invasion,and extent of lymph node dissection.A logistic analysis was performed to identify independent risk factors of chylous leakage.Results 15 (6.5％) patients developed chylous leakage after pancreatioduodenectomy.The average hospital stay after surgery of the study group was 20.8 days,compared to 13.5 days in the control-group (P =0.004).In the study group,chylous leakage rate increased in patients with 14th and 16th group of lymph nodes dissection (80％ vs 36.7％,P =0.006).Logistic analysis showed that 14th and 16th lymph nodes dissection was an independent risk factor of chylous leakage after pancreatioduodenectomy (P ＜ 0.05,OR =6.909,95％ CI 1.593 ～ 29.958).Conclusions Chylous leakage prolonged hospitalization after pancreatioduodenectomy.Dissection of the 14th and 16th lymph node groups was an independent risk factor of chylous leakage after pancreatioduodenectomy.Careful ligation of the gastrocolic vein near the lymphatic trunk and dissection of 14th and 16th group of lymph nodes were effective interventions to reduce postoperative chylous leakage.