Objective To investigate the role of zenapax in the prevention of acute rejection in renal transplant recipients.Methods The medical records of 50 renal transplant recipients treated with one dose of zenapax(study group) and simultaneously 30 renal transplant recipients without treatment of zenapax(control group) were retrospectively analyzed.The follow-up was six months.The incidence of acute rejection,renal allograft function,infection,and adverse effects of zenapax were comparatively analyzed between the 2 groups.Results Acute rejection rate was lower in study group(13/50,26%) compared with that in control group(17/30,57%;P)(0.05)).Conclusions One dose regimen of zenapax as part of immunosuppressive therapy is effective in the prevention of acute rejection in renal transplant recipients.It has less side effects and contributes to the improvement of renal allograft function.

Glycated hemoglobin A1c ( HbA1c) is worldwide used as the gold standard for long term glycemic control in patients with diabetes.Recently,it has been recommended as one of the diagnostic criteria of diabetes mellitus.To improve the accuracy and comparability of HbA1c testing,expedite the standardization of HbA1c assay and make a reasonable interpretation of the HbA1c results in clinical practice are inevitably faced by clinical laboratorians together with physicians.

The social reputation-based incentive mechanisms in preventing the free riding behaviors were put for-ward according to the analysis of personal digital library and P2P technology. Since the reputation value of personal digital library was calculated according to the maximum flow algorithm, personal digital library must increase its reputation value by sharing the resources when it is going to obtain the necessary resources it wants.

Objective To explore the influence of lung IL-10 on interstitial dendritic cells in multiple organ dysfunction syndrome(MODS),and its role in immunological dysfunction.Methods The model of MODS was replicated by injecting zymosan into the peritoneal cavity of C57BL/6 mice.The mice were then randomly divided into normal groups as well as the groups of 3-6 hours,12-48 hours,5-7 days and 10-12 days post trauma.The level of CCR7 mRNA in lung was detected by RT-PCR and the proteins of CCR7 and IL-10 were immunohistochemically stained.The number of mononuclear cells in MHC-II positive peripheral blood was determined by flow cytometry.Results At the early stage of injury(3-6 hours),the number of IL-10 positive cells and the expression of CCR7 increased,but the number of mononuclear cells in MHC-II positive peripheral blood decreased.At the stage of 12-48 hours,the number of IL-10 positive cells and the expression of CCR7 continued to increase obviously,and that of mononuclear cells in MHC-II positive peripheral blood went on decreasing.At the stage of 10-12 days,the number of IL-10 positive cells increased dramatically compared with that in normal group,but the expression of CCR7 declined obviously in contrast to that in 12-48 hours,and the number of mononuclear cells in MHC-II positive peripheral blood decreased to the lowest level.Conclusions The expression of IL-10 in lung could inhibit the excessive immunological damage induced by dendritic cells on the one hand,and it probably leads to immunosuppression by reducing the CCR7 expression of dendritic cells and the number of mononuclear cells in MHC-II positive peripheral blood on the other hand.

Objective To investigate the effectiveness of Rh-negative patients receiving Rh-positive renal grafts.Methods Three Rh-positive kidneys were transplanted in 3 Rh-negative uremia patients respectively. The pre- and intraoperative conditions were evaluated. All patients were regularly followed up.Results Dysfunction occurred in one graft kidney 5 years after the operation, and the patient died of cardiovascular complication 8 years after the operation. The remaining 2 patients have survived 22 and 2 months respectively with normal renal function, and their Rh antibodies were negative 21 and 2 months after the operation respectively.Conclusion Fully perfused Rh-positive renal grafts can be transplanted to Rh-negative uremia patients. The short-term effect is satisfactory.

Objective To learn the present pain management quality at tertiary hospitals in China and the application of the quality evaluation system for acute pain management quality recommended by American Pain Society.Methods Analyzing the present pain management at five tertiary hospitals in China by using the evaluation system recommended by American Pain Society,questionnaires and medical records reading.Results The hospitals were found with setbacks in describing pains,recording pains with tools,using the right pain controls,using non-drug pain control measures and pain management outcomes; differences were found between the acute pain service group and non-acute pain service group in pain management quality,as the pain impacts of both groups on activities,emotion and sleep were 3.12±2.82 and 5.16±2.07 (P＜0.05) respectively.Conclusion Setbacks exist in both the process and outcomes of post-surgery pain management at these hospitals; those with acute pain service management are better than those without in terms of post-surgery pain management quality.The evaluation system recommended by American Pain Society is scientific,sensitive,practical and operable,extensively applicable to evaluation of acute pain management quality at hospitals in China.

Objective To investigate the effects of different concentrations of dexmedetomidine on the expression of Toll-like receptor 4 (TLR4) mRNA in rat peripheral blood monocytes exposed to lipopolysaccharide ( LPS ). Methods Peripheral blood monocytes isolated from male Wistar rats were seeded in 24-well plate in RPMI 1640 liquid culture medium in CO2 incubator at 37 ℃ and 5% CO2 for 2 h, and were randomly divided into 5 groups ( n = 8 each): group A negative control; group B was exposed to LPS 1 μg/ml and C, D and E groups were exposed to LPS 1 μg/ml + dexmetomidine 0.5, 5.0 and 50.0 ng/ml respectively. The monocytes were then incubated for 24 h. The concentrations of TNF-α, IL-1β and IL-6 in the supernatant of the cultured monocytes were detected by ELISA. The expression of TLR4 mRNA in the monocytes was detected by RT-PCR.Results Exposure to LPS significantly increased the expression of TLR4 mRNA and the concentrations of TNF-α, IL-1β and IL -6 in group B as compared with group A ( P ＜ 0.01 ). Dexmedetomidine attenuated the LPS-induced increase in the expression of TLR 4 mRNA and the concentrations of TNF-α, IL-1β and IL-6 in a dose-dependent manner ( P ＜0.05or 0.01 ). Conclusion Dexmedetomidine can inhibit the synthesis of TLR4 and inhibit the secretion and dilivery of TNF-α, IL-1β and IL-6 by down-regulating the gene expression of TLR4 in rat peripheral blood monocytes exposed to LPS.

Objective To observe reverse effect of anisodamine to the adverse effect of remifentanil during enteroscopy without pain for patients with bradycardia .Methods Sixty‐five patients with bradycardia were selected and divided randomly into group C (n=21 ,control group)、group A1 (n=22 ,anisodamine by instillation) and group A2 (n=22 ,anisodamine by continous infusion) .In‐duction :Intravenous etomidate 0 .08 mg/kg ,propofol 1 .00 mg/kg and remifentanil 0 .10μg/kg in 3 groups .Ten mg anisodamine in‐fused by instillation before induction in group A1 ,5 mg anisodamine infused by instillation before induction and continous infused by 0 .25 mg/min in group A2 .Maintenance:All group received propofol 4 mg · kg‐1 · h‐1 ,remifentanil 0 .05 μg · kg‐1 · min‐1 after un‐dergoing enteroscopy .stopping pumping propofol when colonoscopy reached ileocecal junction ,and we took off remifentanil when colonoscopy withdraw to decending colon .Then we observed and recorded HR ,SpO2 ,MAP ,dosage ,fluid infusion ,induction time , check time ,analepsia time ,degree and of enterospasm and numbers of cases and side effect at T0 (before induction) ,T1 (beginning of operation) ,T2 (into the transverse colon) ,T3 (to the ileocecal junction) ,T4 (exit) .Results There were no significant difference a‐mong 3 groups of induction time .Compared with group A1 and group A2 about check time and analepsia time ,group C was much shorter .The HR of group A1 and A2 were more stable than group C at T2 、T3 .At T1 、T2 ,the fluctuation of HR of group A2 was less than that of group A1 .There was obviously different among 3 groups of propofol′s dosage ,operation time and enterospasm ,the effect of group A1 and group A2 were better .There was statistically significant in number of cases of body movement between group A1 (1/22)and group C(4/21) ,there was also statistical significance between group A1 ,group A2 and group C(P<0 .05) .Conclusion There are no difference between 2 methods about relieving enterospasm ,refraining intestinal angina ,shortening operation time , saving anesthetic dosage .Effect of continous pumping to undulation of HR may be more stable .

Objective To observe and evaluate the clinical effect of submental island myocutaneous flap(SIMF) and free skin graft(FSG) for the reconstruction of buccal defect resulted from the buccal carcinomas .Methods Forty-four aged aging patients di-agnosed with the buccal carcinomas were operated by the total dissection of primary tumor and selective neck dissection and recon-structed simultaneously with SIMF(19 cases) and FSG(25 cases) .The degree of postoperative cheek shape ,limitation of mouth o-pening ,speech sound ,and function of chewing were observed and analyzed .Results Eighteen SIMFs were completely survived .The residual muscle flap had a good blood supply after the debridement of skin island in one case ,the successful rate of flaps was 94 .7%(18/19) while 100% (25/25) .The donor site of SIMF was sutured directly .Follow-up was taken in 12 months for all patients .In SIMF group ,the degree of postoperative cheek shape ,limitation of mouth opening ,speech sound ,and function of chewing were bet-ter than those of FSG group in FSG group(P<0 .05) .There was no significant difference between 2 groups in the field of recur-rence and metastasis although the recurrence adjacent to the primary tumor had happened in FSG group in 5 months after operation (P>0 .05) .Conclusion The submental island flap is an excellent choice for the reconstruction of cheek defects in aging patients af-ter resection of buccal carcinoma .With acceptable cosmetic ,functional results and reasonable oncological saftety ,SIMF has a prom-ising prospect in head and neck surgery .

BACKGROUND:Silk fibroin/mesoporous glass ceramic composites have been reported to exert satisfactory repair outcomes in bone defects and hold good biocompatibility. However, the biosafety and preparation methods are rarely reported. OBJECTIVE:To investigate the preparation method and treatment outcomes of silk fibroin/mesoporous bioactive glass ceramic in skul repair. METHODS:Thirty-two Sprague-Dawley rats were enrol ed to establish the skul defect models and were thenrandomized into two groups:fibroin/mesoporous glass ceramic materials and silk fibroin were respectively implanted into the defect region in experimental and control groups. At 4 and 8 weeks after implantation, the CT examination and histological observation were performed. RESULTS AND CONCLUSION:CT examination showed that at 4 weeks after implantation, the defect area in the experimental group diminished in size, showing more dense new bones. The defect area of the control group was reduced, and a smal amount of new bones were observed. At 8 weeks after implantation, bone defect repair was completed in the experimental group, but not in the control group. The bone volume in the experimental group was significantly larger than that in the control group at different time points after implantation (P<0.05). Hematoxylin-eosin staining found that at 4 weeks after implantation, in the experimental group, there was new bone between the implant and the bone, which did not cause inflammation;there were few new bones and fibrous tissues in the control group. At 8 weeks after implantation, many new bones formed in the experimental group, with similar morphology to the host bone and the scaffold was degraded completely. Conversely, the implant material stil existed in the control group. In conclusion, the silk fibroin/mesoporous glass ceramic composite can promote bone repair.