Objective To analyze the causes and outcome of conversion from tacrolimus (FK506) to cyclosporine-A (CsA) in recipients after liver transplantation.Methods 317 consecutive liver transplantation recipients in our department received anti-CD25 monoclonal antibody,FK506, mycophenolate mofetil and corticoid for prophylaxis of cellular rejection.The blood FK506 trough level was (10-15)?g/L within the first 30 days,(8-12)?g/L within next 60 days,and (5-8)?g/L was kept during 90 to 180 days after transplantation.All recipients reveived a follow-up of 6 months. Remits Sixteen out of 317 recipients (5.05%) required conversion from FK506 to CsA.The clinical indications for conversion included:neurological adverse effect of FK506 in 5 cases (31.25%),hema- tological adverse effect in 2 cases (12.5%),gastrointestinal effect in one case (6.25%),not capable of reaching therapeutic window concentration in 3 cases (18.75%),refractory hyperglycemia in 2 ca- ses (12.5%),and economic factor in 3 cases (18.75%).The majority of recipients demonstrated clinical improvement after the switch,except 2 of 16 patients (12.5%) had to be reconverted to FK506 due to renal disadvantage.No dead recipient and adverse effect correlated to immunosuppres- sive agent conversion were seen.Conclusion If necessary,conversion from FK506 to CsA in patients undergoing liver transplantation is safe and effective.

Objective To investigate the application of the central venous catheter (CVC) specialized for drainage intervention in severe acute pancreatitis (SAP) patients.Methods Sixty-two severe acute pancreatitis patients with seroperitoneum were randomly (random number) assigned into two groups:the drainage group (n =31) and the control group (n =31).All patients were treated with conventional internal medicine therapy.Patients of drainage group were treated with continuous peritoneal drainage by using the central venous catheter.The intra-abdominal pressure (IAP),lactic acid (LAC),and procalcitonin (PCT) were detected before and 12 h,24 h,48 h,72 h,5 days after intraperitoneal drainage.The symptoms of abdomen pain,abdomen distention,resume of bowel movement and the rate of MODS were observed.Results All patients with drainage got catheter successfully inserted.Compared with the control group,the IAP,LAC and PCT decreased significantly in the patients of drainage group.And the duration of abdomen pain,abdomen distention and resume of bowel movement function in the drainage group were shorter and the rate of MODS was lower.Conclusions Application of CVC specialized for intraperitoneal drainage is a safe and effective method for the treatment of pancreatitis with seroperitoneum.It is worthwhile to be widely used in clinic.

OBJECTIVETo investigate the absolute bioavailability of caffeic acid in rats and its intestinal absorption properties.

METHODThe absolute bioavailability (Fabs) of caffeic acid was obtained after iv (2 mg x kg(-1)) or ig (10 mg x kg(-1)) administration to rats. The intestinal absorption of caffeic acid was explored by the recirculating vascularly perfused rat intestinal preparation. Caco-2 cell model was applied to measure the permeability of caffeic acid from apical to basolateral said (A-B) and from basolateral to apical said (B-A).

RESULTA two-compartment pharmacokinetic model was best to describe the pharmacokinetics of caffeic acid following iv or ig administration. The Fabs of caffeic acid was 14. 7% , and its intestinal absorption was 12.4%. The values of Papp A-->B and Papp B-->A of caffeic acid were retained stable while its concentration was changed. The efflux ratio values in this study surveyed were above 2.0, and suggesting caffeic acid was active transport.

CONCLUSIONCaffeic acid was shown to have poor permeability across the Caco-2 cells, low intestinal absorption and low oral bioavailability in rats.

Animals ; Biological Availability ; Caco-2 Cells ; Caffeic Acids ; metabolism ; pharmacokinetics ; Humans ; Intestinal Absorption ; Male ; Rats ; Rats, Sprague-Dawley

BACKGROUNDAspermia caused by exogenous testosterone limit its usage in late-onset hypogonadism (LOH) patients desiring fertility. Saikokaryukotsuboreito (SKRBT) is reported to improve serum testosterone and relieve LOH-related symptoms. However, it is unclear whether SKRBT affects fertility. We aimed to examine the effects of SKRBT on spermatogenesis and fertility in aging male mice.

METHODSThirty aging male mice were randomly assigned to three groups. Mice were orally administered with phosphate-buffer solution or SKRBT (300 mg/kg, daily) or received testosterone by subcutaneous injections (10 mg/kg, every 3 days). Thirty days later, each male mouse was mated with two female mice. All animals were sacrificed at the end of 90 days. Intratesticular testosterone (ITT) levels, quality of sperm, expression of synaptonemal complex protein 3 (SYCP3), and fertility were assayed.

RESULTSIn the SKRBT-treated group, ITT, quality of sperm, and expression of SYCP3 were all improved compared with the control group (ITT: 85.50 ± 12.31 ng/g vs. 74.10 ± 11.45 ng/g, P = 0.027; sperm number: [14.94 ± 4.63] × 106 cells/ml vs. [8.79 ± 4.38] × 106 cells/ml, P = 0.002; sperm motility: 43.16 ± 9.93% vs. 33.51 ± 6.98%, P = 0.015; the number of SYCP3-positive cells/tubule: 77.50 ± 11.01 ng/ml vs. 49.30 ± 8.73 ng/ml, P < 0.001; the expression of SYCP3 protein: 1.23 ± 0.09 vs. 0.84 ± 0.10, P < 0.001), but fertility was not significantly changed (P > 0.05, respectively). In the testosterone-treated group, ITT, quality of sperm, and expression of SYCP3 were markedly lower than the control group (ITT: 59.00 ± 8.67, P = 0.005; sperm number: [4.34 ± 2.45] × 106 cells/ml, P = 0.018; sperm motility: 19.53 ± 7.69%, P = 0.001; the number of SYCP3-positive cells/tubule: 30.00 ± 11.28, P < 0.001; the percentage of SYCP3-positive tubules/section 71.98 ± 8.88%, P = 0.001; the expression of SYCP3 protein: 0.71 ± 0.09, P < 0.001), and fertility was also suppressed (P < 0.05, respectively).

CONCLUSIONSKRBT had no adverse effect on fertility potential in aging male mice.

Aging ; Animals ; Drugs, Chinese Herbal ; pharmacology ; Fertility ; drug effects ; Hypogonadism ; drug therapy ; Male ; Mice ; Nuclear Proteins ; analysis ; Sperm Count ; Sperm Motility ; drug effects ; Spermatogenesis ; drug effects ; Testis ; drug effects ; pathology ; Testosterone ; blood

Objective To explore the relationship between NF-kB1-94ins/delATTG gene polymorphism and acute progressive cerebral infarction(APCD ofChinese Hart population in Qingdaodistrict Methods We detected the polymorphism of NF-κB1 -94ins/delA TTG gene in 100 patients with acute cerebral infarction (ACI group) and 99 patients with acute progressive cerebral infarction (APCI group) by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)analysis. The changes of expression of NF-κBp65 in PBMC cellular nucleus in the 2 groups were detected by cell immunohistochemistry. Results The frequency of TT genetype and T allele in the APCI group was significantly higher than that in the ACI group (P<0.05). Analysis on the relative risk of allele frequency showed that patients with T allele had 1.622 times of risk in having APCI than patients with C allele; logistic regressive analysis indicated that NF-κB1 TT genotype was independently related to the attacking of APCI (OR=2.14, 95% CI: 2.654-8.296, P<0.05). The expressions of NF-κBp65 of PBMC cellular nucleus of TT genotypic individuals in APCI group were significantly higher than those in ACI group (P<0.05); logistic regressive analysis indicated that the expressions of NF-KBp65 in PBMC cellular nucleus of TT genotypic individuals were independently related to the attacking of APCI (OR=1.96; 95% CI: 2.267-7.691; P<0.05). Conclusion The NF-κB1 gene polymorphism might participate in the onset of APCI and T allele of NF-κB1 gene might be a genetic risk factor of getting APCI for Chinese Han populations in Qingdao district. The NF-κB1 T allele carrier might increase the happening of APCI through up regulating the expression of NF-kB1.

OBJECTIVETo summarize the clinical efficacy of pediatric liver transplantation, and investigate the characters of pediatric liver transplantation in their indications, surgical procedures and postoperative management.

METHODSFrom August 2000 to March 2007, 23 liver transplantations were performed on 20 children, aging from 6 months to 13 years old. The most common indications were biliary atresia, Wilson's disease, glycogen storage disease and urea cycle defects. Surgical procedures included 4 living donor liver transplantations, 1 Domino liver transplantation, 5 split grafts, 10 reduced liver grafts and 3 whole cadaveric grafts. The triple-drug (FK506, steroid and MMF) immunosuppressive regimen was used in 19 children, except one children using cyclosporine.

RESULTSThree children died of primary non-function, heart failure and abdominal infections respectively during peri-operative period, and the mortality was 15.0%. Nine children showed different post-operative complications including 2 hepatic artery thrombosis, 1 portal vein thrombosis, 1 acute rejection, 3 biliary leakage, 2 biliary stricture, 2 intestinal fistula, 3 abdominal infection, 1 pulmonary infection and 1 heart failure. Cumulative patient survival rates at 6-month, 1-and 2-year were 80.0%, 73.9% and 73.9%, respectively.

CONCLUSIONSLiver transplantation is an effective option to cure the liver disease of children with end-stage. Different surgical procedure could be chosen according to the children's age and body weight.

Adolescent ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; administration & dosage ; Infant ; Liver Transplantation ; methods ; Male ; Postoperative Complications ; therapy ; Retrospective Studies ; Survival Rate ; Treatment Outcome

BACKGROUNDAlthough liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements.

METHODSThirty-one children (< or = 18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months.

RESULTSFive of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.

CONCLUSIONSThe most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Liver Transplantation ; adverse effects ; mortality ; Male ; Postoperative Complications ; etiology ; Retrospective Studies ; Survival Rate

OBJECTIVETo determine the predictive value of HATCH score on recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA).

METHODSThe data of 123 consecutive AF patients (74 paroxysmal and 49 persistent AF) who underwent RFCA between April 2009 and December 2010 in our department were retrospectively analyzed. Of theses patients, 65 (52.9%) patients had HATCH score = 0, 41 (33.3%) patients had HATCH score = 1, and 17 (13.8%) patients had HATCH score ≥ 2 (HATCH = 2 in 11 patients, HATCH = 3 in 5 patients, HATCH = 4 in 1 patient). The recurrence was defined as atrial tachyarrhythmia lasting more than 30 seconds after 3 months post RFCA. The patients were divided into recurrence group and no recurrence group. Relationship between HATCH score and recurrence was observed.

RESULTSThere were 43 cases in recurrence group and 80 cases in no recurrence group. After 12 months follow-up, HATCH score was significant higher in recurrence group than in non-recurrence group [(0.91 ± 0.94) score vs. (0.53 ± 0.80) score, P < 0.05]. The ratio of patients with HATCH ≥ 2 in recurrence group was higher than in non-recurrence group [23.3% (10/43) vs. 8.8% (7/80), P < 0.01]. The sensitivity and specificity of HATCH ≥ 2 to define the risk of recurrence was 25.0%, 92.4% respectively. Cumulative non-recurrence rate of patients with HATCH score ≥ 2 was lower than patients with HATCH score = 0 and 1 (P < 0.05).

CONCLUSIONHigher HATCH score is associated with increased risk of AF recurrence post RFCA.

Aged ; Atrial Fibrillation ; diagnosis ; surgery ; Catheter Ablation ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Recurrence ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate laparoscopic radical gastrectomy for early gastric cancer.

METHODSA total of 204 patients with early gastric cancer undergoing laparoscopic-assisted radical gastrectomy or open radical gastrectomy between October 2004 and December 2009 were retrospectively reviewed and analyzed. Patients were divided into laparoscopic group(LAP, n=78) and open group (OPEN, n=126). Operative time, blood loss, time to passage of flatus, postoperative hospital stay, complications and pathologic findings were compared between the two groups.

RESULTSCompared to the OPEN group, operative time in the LAP group was significantly shorter[(202.9±45.6) min vs.(219.8±45.2) min, P<0.05], blood loss was less[(144.5±146.5) ml vs. (245.0±146.4) ml, P<0.05], time to passage of flatus was shorter[(3.1±1.1) d vs.(4.5±1.6) d, P<0.05], postoperative hospital stay was shorter[(10.8±1.2) d vs. (12.4±3.8) d, P<0.05]. However, the two groups were comparable with regard to postoperative complication rate(10.3% vs. 12.7%, P>0.05), proximal resection margin[(4.0±1.9) cm vs. (4.2±1.7) cm, P>0.05], distal resection margin [(3.6±1.7) cm vs. (3.5±1.8) cm, P>0.05], number of harvested lymph node(13.1±6.5 vs. 14.5±8.2, P>0.05). The median follow up was 22(2-64) months. There were no tumor recurrences or metastases in the LAP group. In the OPEN group, only 1 patient died from peritoneal metastasis. Total hospital costs between the two groups were similar(P>0.05).

CONCLUSIONLaparoscopic radical gastrectomy is a safe, feasible, effective, and less invasive surgery for early gastric cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Laparotomy ; Lymph Node Excision ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

Objective To explore the feasibility and related factors of using semen samples from condoms collected by their female sex workers (FSWs) for HIV-antibody testing. Methods FSWs were recruited by outreach workers. Semen samples from condoms of their sexual partners (paid or regular) were collected by FSWs themselves after intercourse and for HIV testing. Male partners were asked to participate in the study. Questionnaires were administered for both FSWs and their male sexual parmers. Blood samples were also collected for HIV testing. Results In total, 54 FSWs with 43 of their regular sexual partners and 57 casual clients were recruited. HIV prevalence,determined from serum samples, were 33.33% among FSWs, 29.82% and 23.26% among their clients and regular sexual partners. 40.35% and 30.23% of the semen samples from the condoms they used,were tested positive for HIV among clients and regular sexual partners of the FSWs. The sensitivity of semen samples from condoms for HIV-antibodies was 100% among both clients and regular sexual partners of the FSWs, while the rates of specificity were 85.00% and 90.91% respectively. Data from Univariate analysis indicated that among FSWs, factors as the characteristics of self-reported needle sharing and the male sexual partners who had one child, were associated with the disparity between serum and condom semen sample for HIV-antibody testing. Conclusion HIV prevalence in male clients and regular sexual partners of the FSWs might be overestimated according to the HIV-antibody testing results of semen samples from condoms collected by FSWs themselves. Lower specificity indicated that FSWs with positive HIV might have contaminated the semen samples from the condom used by their HIV negative sexual partners.