Objective To investigate a safe method for donor's hepatectomy in living donor liver transplantation (LDLT).Methods Of the 14 patients with endstage liver diseases undergoing LDLT successfully since Jan. 1995, 2 cases were subjected to extensive left lateral hepatetomy,10 to extensive left hepatetomy including middel hepatic vein and 2 to right hepatetomy. Results Bile leakge occurred only in one patients after removal of the T tube. All patients received a period of 1 month to 5 years. No complain was found. The function of the liver in all patients was normal. Conclusion The operative risk of donor hepatetomy is minimal if it is performed by experienced liver surgeons.

Objective To assess compliance in liver transplant recipients,ascertain related factors,and help clinical nunrses take measures to improve compliance. Methods Questionnaires including social demo-graphic variables and questionnaire about compliance after liver transplant,were used to investigate 54 liver transplant recipients whose post transplant time>6 months.Results Liver transplant recipients had good compliance to immunosuppressive medication,scored(3.67±0.51),and health lifestyle,scored(3.30±0.44),but relatively poor compliance to follow-up.scored(3.05±0.89)and self-monitoring,scored(2.00±0.89).The main factors influencing the compliance were average monthly per capita family income(P<0.01)and post trans-plant time(P<0.01).Conclusions The importance of compliance to follow-up and self-monitoring should be emphasized in health education to the recipients and more attention should be paid to those re-cipients with lower income or longer post transplant time.

BACKGROUND: It has been considered that Cestrum nocturnum L. (CNL) has the effects of antiarrhythmia, local anesthesia and central inhibition.OBJECTIVE: To investigate the analgesic effect of CNL extract on mice,so as to find new drugs for clinical treatment of pain.DESIGN: A randomized control observation.SETTING: Center of Modern Education and Department of Pharmacology,Gannan Medical College.MATERIALS: The experiments were carried out in the laboratory of scientific research center, Gannan Medical College between March and April in 2005. ① A total of 150 healthy adult Kunming mice were used in four independent experiments. ② Drugs: CNL extract was provided by the Department of Phytochemistry, Shenyang Pharmaceutical University (batch number: 2002080901), morphine hydrochloride injection by Shenyang No.1Pharmaceutical Factory (batch number: 000305), and naloxone hydrochloride injection by Yanqiao (Hunan) Pharmaceutical Co. Ltd., (batch number:20021109).METHODS: ① Effects of CNL extract on writhing times induced by acetic acid: Forty female mice were randomly divided into four groups with10 mice in each, and they were treated with intraperitoneal injections of 0.02 mL/g saline, 0.10 and 0.20 mg/g CNL extract and 0.10 mg/g aminophenazone respectively. The intraperineal injection of 6 g/L glacial acetic acid was given after 15 minutes. The writhing times of mice within 15 minutes were observed and recorded in each group. ② Effects of CNL extract on the pain induced by hot pla in mice: Forty female mice were randomly divided into four groups with 10 mice in each, and they were treated with intraperineal injections of 0.02 mL/g saline, 0. 10 and 0.20 mg/g CNL extract and 0.10 mg/g morphine respectively. The pain responses were detected at 15, 30 and 60 minutes after administration. ③ The antagonistic effect of naloxone on morphine and CNL extract to the pain induced by hot plate in mice: Thirty female mice were randomly divided into three groups ith 10 mice in each group, and they were given intraperitoneal injections of 0.02 mL/g saline, naloxone 0.004 mg/g +morphine 0.01 mg/g and naloxone 0.004 mg/g+CNL extract 0.01 mg/g respectively. The pain responses were detected at 15, 30 and 60 minutes after administration respectively. ④ Effects of CNL extract on electrostimulation induced pain in mice: Forty mice were randomly divided into four groups with 10 mice in ach group, and they were administrated with intraperineal injections of 0.02 mL/g saline, 0.10 and 0.20 mg/g CNL extract and 1 g/L morphine respectively. Repeated electrostimulations were given at 20, 35, 50 and 70minutes after administration, and the pain responses were detected by means of electrostimulation.MAIN OUTCOME MEASURES: ① Writhing times; ② Time for the pain response induced by hot plate; ③ Analgesic rate induced by electrostimulation.RESULTS: Totally 150 healthy adult Kunming mice were used in the four independent experiments, and all were involved in the analysis of results. ①Writhing times in the mice: 0.10 and 0.20 mg/g CNL extracts and 0.10 mg/g aminophenazone had very significant analgesic effects on writhing induced byacetic acid in mice, and the writhing times after administration were all fewer than those in the saline group (20.2±10.8, 14.5±7.6, 7.6±4.5,50.6±15.5, P ＜ 0.01), and the analgesic effects of CNL extract were dosedependently. ② Time for the pain response induced by hot plate: 0.10 and 0.20 mg/g CNL extracts had significant analgesic effects on the pain in duced by hot plate, and the time for pain sensation at 15, 30 and 60 minutes after administration were all longer than those in the saline group (P ＜ 0.05 or P ＜ 0.01), and the analgesic effect was dose-dependently. The times for pain sensation at each time point after administration in the naloxone 0.004 mg/g+CNL extract 0.01 mg/g group were all longer than those in the saline group, but those were close between the naloxone 0.004 mg/g+morphine 0.01 mg/g group and the saline group. ③ Analgesic rate induced by electrostimulation in the mice: The analgesic rates at20, 35, 50 and 70minutes after administration in the CNL extract 0.10 and 0.20 mg/g groups were all higher than those in the saline group (P ＜ 0.01).CONCLUSION: Our data suggested that CNL extract has obvious analgesic effect, and the analgesic intensity is dose-dependently. Naloxone, an opiate receptor antagonist, can antagonize the analgesic effect of morphine,but cannot antagonize that of CNL extract on mice with pain induced by hot plate, which indicates that CNL extract exert its analgesic role not through binding with opiate receptor.

Objective To evaluate living-related liver transplantation (LRLT) for the treatment of Wilson′s disease. MethodsBetween Jan. 2001 and Oct. 2003,LRLT was performed in 20 patients (mean age 11.1 years) of late staged Wilson′s disease. Among them emergency transplantation was performed in 3 patients. Donor livers were all from patient′s parents. ResultsSurgery was successful in all donors and recipients, liver function test and serum ceruloplasmin reached normal level one month after transplantation. One patient died of severe rejection. Discharged patients were followed up from 2～33 months (mean 18.9 months). [WT5”HZ]ConclusionsLiving related liver transplantation is an effective treatment for Wilson′s disease complicated with hepatic dysfunction.

ObjectiveTo analyze a case of death after inoculation of a freeze-dried rabies vaccine for human use so as to provide reference for the vaccination of the rabies vaccine and the process of investigation and diagnosis involving adverse events following immunization （AEFI） in the future. MethodsData on vaccination， clinical symptoms， treatments， investigation and diagnosis were collected and analyzed. ResultsRabies post-exposure prophylaxis and vaccination were in line with the protocols. On the 3rd day after the inoculation of the rabies vaccine， the patient developed fever， weakness， headache， dizziness， diarrhea and other symptoms. The white blood cell count and neutrophil count increased progressively. At about 17：00 on the same day， the patient suffered a sudden cardiac arrest and died clinically. Autopsy was not carried out. ConclusionThe cause of sepsis /septic shock of the patient is unknown. It is necessary to formulate detailed rabies immunization procedures as well as norms and expert consensus in the field of investigation and diagnosis of AEFI.

Bone Wires ; Child ; Child, Preschool ; External Fixators ; Female ; Fracture Fixation ; methods ; Humans ; Humeral Fractures ; surgery ; Male

Objective To study PPARγ inhibitor(GW9662) ,on colon cancer SW480 cell proliferation and apoptosis intervened by Nimesulide(N) in vitro ,in order to investigate the role of PPARγpathway in colon cancer cell proliferation inhibition and apop‐tosis promotion induced by Nimesulide .Methods Cells were divided into 4 groups ,namely :the control group ,GW9662 group (GW9662 0 .1 ,0 .5 ,1 .0 ,5 .0μmol/L) ,N group ,GW9662+N group .MTT assay and FCM were used to determine proliferation ,ap‐optosis and cell cycle of SW480 cells .And the expression of PPARγ,p21Waf1 ,p27Kip1 ,Bcl‐2 ,Bax ,VEGF proteins were measured by Western‐blot .Results N inhibited SW480 cells proliferation in a time‐dependent manner (P< 0 .01) .During a special range , GW9662 attenuated effect of nimesulide inhibiting SW480 cells proliferation in a dose‐and time‐dependent manner .The results of FCM showed :the apoptosis rates of SW480 cells had no statistical change between GW9662 group and control group(P>0 .05) . Cell apoptosis rate of group N increased significantly ,compared with control group(P<0 .01) .The apoptosis rates of SW480 cells incubated with Nimesulide and GW9662 dropped significantly compared with Nimesulide alone (P<0 .01) .Above results showed that GW9662 could attenuate the effect of nimesulide on cell apoptosis and cell cycle .The results of Western‐blot :Compared with the control group ,the expression of PPARγ,p21Waf1 ,p27Kip1 ,Bax protein were up‐regulated significantly in nimesulide group(P<0 .05 or P<0 .01) ,but Bcl‐2 and VEGF were down‐regulated significantly(P<0 .01) .Compared with the nimesulide group ,the expres‐sion of PPARγ,p21Waf1 , p27Kip1 and Bax protein were down‐regulated obviously in GW9662+N group(P<0 .05 or P<0 .01) .Corre‐spondingly ,Bcl‐2 and VEGF were up‐regulated obviously(P<0 .05) .Conclusion N could effectively inhibit SW480 cell prolifera‐tion and induce its apoptosis .PPARγpathway may play an important role in proliferation inhibition and apoptosis induced by Nime‐sulide in colon cancer cell .

Objective To explore the effects and related mechanism of Exendin-4 on secretion of extracellular matrix in high glucose-induced glomerular mesangial cells(GMCs). Methods GMCs were incubated in medium with glucose or Exendin-4 for the four groups: normal glucose group(NG group): cells were treated in medium with 5.6 mmol/L glucose; NG with Exendin-4 treatment group(NGE group): cells were treated with 5.6 mmol/L glucose and Exendin-4; high glucose group(HG group): cells were cultured with 30 mmol/L glucose; HG with Exendin-4 treatment group(HGE group): cells were treated with 30 mmol/L glucose and Exendin-4 at concentration of 3, 5, 10, 15, 30 nmol/L separately, which were cultured for 12, 24, 48 hours. GMCs treated with Exendin-4 were determined by assessing proliferation using a CCK8 method. The levels of fibronectin(FN), collagen type Ⅳ(Col-Ⅳ)in the cell supernatant were measured using enzyme-linked immunosorbent assay(ELISA). The gene levels of Col-Ⅳ, FN, and expression of inflammatory mediators including monocyte chemotactic protein 1(MCP-1), tumor necrosis factor-α(TNF-α), intercellular cell adhesion molecule-1(ICAM-1), transforming growth factor-β1(TGF-β1)were evaluated using reverse transcription PCR(RT-PCR); The expression of nuclear transcription factor-κB(NF-κB), glucagon-like peptide-l receptor(GLP-1R), and phosphorylation levels of mitogen-activated protein kinases(MAPKs)were evaluated by Western blot. Results(1)After treatment with 10 nmol/L Exendin-4 for 24 hour, the proliferation rate of GMCs was significantly decreased compared with 3 nmol/L, 5 nmol/L Exendin-4 treatment(P<0.05), while there was no difference compared with 15 nmol/L, 30 nmol/L Exendin-4 treatment(both P>0.05). (2)The gene expression of FN, Col-Ⅳ and the inflammatory mediators, MCP-1, TNF-α, ICAM-1, TGF-β1 in HG group were significantly increased compared with the NG group,(all P<0.05). After treatment with Exendin-4, the levels of FN, Col-Ⅳ and the gene expression of TNF-α, MCP-1, ICAM-1, TGF-β1 were decreased(all P<0.05). (3)Compared with NG group, the expression of NF-κB and the phosphorylation of extracellular regulated protein kinases(p-Erk1/2), Jun N-terminal kinase(p-JNK)and, p38MAPK(p-p38MAPK)in the group of HG group were increased significantly, accompanied by the decrease of GLP-1R protein level(all P<0.05). Importantly, Exendin-4 treatment significantly reduced protein expression of p-Erk1/2, p-JNK, and NF-κB(all P<0.05), and the level of GLP-1R protein increased(P<0.05). Furthermore, specific Erk1/2, JNK or NF-κB inhibitors markedly blocked Exendin-4-mediated decrease in the levels of FN, Col-Ⅳ. Conclusion Exendin-4 treatment inhibits the secretion of extracellular matrix potentially through Erk1/2, JNK/NF-κB signaling in higher glucose induced GMCs.

objective To investigate preoperative donor and recipient assessment,choice of surgical options in living donor liver transplantation(LDLT).Methods The clinical data of 95 patients who underwent LDLT from January 1995 to October 2007 in our center were retrospectively analyzed.Of all,92 recipients were benign end-stage liver disease patients (including 45 patients with Wilson disease),and 3 were malignant hepatic carcinbma patients.Results Thirty-one fight lobes without middle hepatic vein(MHV),3 right lobes with MHV,51 left lobes with MHV.and 10 left lobes or left lateral lobes without MHV were obtained.All the donors recovered after operation. Recipients with benign end-stage liver disease were followed up for 1 to 86 months,and the 1-,3-,5-year accumulative survival rates were 89%(82 cases),78%(71 cases)and 73%(67 cases),respectively. The 1-,3-,5-year survival rates of patients with Wilson disease were 92%(42 cases),89%(40 cases)and 76%(34 cases),respectively. For the 3 patients with malignant hepatic carcinoma,2 died and 1 was alive and well. The copper metabolism was back to normal in both donors and recipients. Conclusions Establishment of a system for the safety of donors is basic for LDLT. The key to raise the recipients' survival rates is to choose the optimal surgical approach. LDLT is effective in treating Wilson disease.

Objective To study the sedative and analgesic effects of butorphanol combined with midazolam on critically ill patients treated by mechanical ventilation. Methods Fifty-eight patients who received mechanical ventilation, sedation and analgesia in intensive care unit (ICU) of Affiliated Huaian No.1 Hospital of Nanjing Medical University from January 2012 to December 2013 were enrolled. The patients were divided into a single midazolam group (30 cases) and a combination of butorphanol and midazolam group (combination with butorphanol group, 28 cases) according to the difference in types of sedative. The sedation for patients in the single midazolam group was induced firstly by intravenous injection of 0.05-0.10 mg/kg midazolam and followed by continuous infusion of the same drug 0.05 - 0.15 mg·kg-1·h-1 with a micro injection pump. The patients in the combination with butorphanol group were given a loading dose of butorphanol 10μg/kg and followed by continuous infusion of 10-20μg·kg-1·h-1 butorphanol combined with 0.05 - 0.15 mg·kg-1·h-1 midazolam by a micro pump. The Ramsay anesthesia score and visual analogue scale (VAS) were used to evaluate the sedative and analgesic effects. According to the Ramsay score, the sedation depths of patients in the two groups were maintained at 2-4 grades, and reassessed every 1-2 hours. The mean arterial pressure (MAP), heart rate (HR) and pulse blood oxygen saturation (SpO2) were observed before and after the drug administration in two groups. Results There were no statistically significant differences in MAP, HR and SpO2 between single midazolam group and combination with butorphanol group before treatment [MAP (mmHg, 1 mmHg=0.133 kPa): 121.3±6.2 vs. 118.6±8.7, HR (bpm):129.5±14.1 vs. 125.5±16.3, SpO2:0.744±0.112 vs. 0.756±0.131, all P>0.05]. Compared with those before treatment, after treatment, the above indexes in two groups were significantly improved, the differences being statistically significant [single midazolam group:MAP (mmHg) 88.7±6.5 vs. 121.3±6.2, HR (bpm) 85.3±13.4 vs. 129.5±14.1, SpO2 0.937±0.056 vs. 0.744±0.112; combination with butorphanol group: MAP (mmHg) 82.6±7.3 vs. 118.6±8.7, HR (bpm) 89.6±14.7 vs. 125.5±16.3, SpO2 0.943±0.078 vs. 0.756±0.131, all P < 0.05], and the degree of improvement of the combination with butorphanol group was better than that of the single midazolam group. The initial acting time of drugs and the time awakening from anesthesia in the combination with butorphanol group were shorter significantly than those in the single midazolam group (minutes: 33.6±6.2 vs. 73.3±12.2, 71.8±19.3 vs. 103.5±30.1, both P < 0.05), and the incidence of adverse reaction was lower obviously than that in the single midazolam group (0 vs.13.3%, P < 0.05). Furthermore, the score of VAS in the combination with butorphanol group was lower significantly than that in single midazolam group (8.4±1.2 vs. 2.4±0.8, P < 0.05). Conclusions Butorphanol combined with midazolam for treatment of critically ill patients with mechanical ventilation is a very effective sedative method, which may improve the degree of patients' tolerance towards the measure and reduce the incidence of adverse reactions.