Clinical practice of anesthesia is an important phase for interns to be professional physicians.In order to improve teaching quality of anesthesiology,we should attach great importance to following three aspects:stressing medical ethics and standardize medication,inspiring activity of the students,reinforcing self-construction of the teachers.Mutual action between teaching and learn-ing can only bring about the improvement of teaching quality in anesthesiology.

Objective: To study the bonding interface characteristic of five wet bonding systems while bonding on different dentin bonding surfaces. Methods: Rhodamine B was used to label five adhesives(OptiBond Sol o,Single Bond,Gluma One-Bond,Bond-1 and One-Step) in consistency of 0.1%, an d the bonding interface of the 5 wet bonding systems on dry or wet dentin surfa ces was observed with laser scanning confocal microscope. Results: All five bonding systems could infiltrate well into dentin bonding interface when bonding on wet dentin surface. The fluorescence confocal images gave eviden ce of the adhesives penetrated into the widened tubules, lateral tubules and dem ineralized peritubular dentin. Little discontinuity in dentin tubular was observ ed in the images, especially in those of alcohol-water-based adhesives. When b onded in dry dentin surface, the hybrid thickness of acetone-based adhesives de creased significantly. Conclusion: The penetration ability of ad hesives may be reduced significantly on dry dentin surface.

OBJECTIVE: To establish a SPE-HPLC method to determine the whole blood concentration of sirolimus.METHODS: The blood sample was treated on Waters OASIS SPE column in which a Supelcosil LC-18DB chromatographic column(250 mm?4.6 mm,5 ?m) was adopted and the temperature was set at 50 ℃.The mobile phase was a mixture of methanol and water(75∶25) at a flow rate of 1.5 mL?min-1.The UV detector was operated at 276 nm.RESULTS: The assay procedure was shown to produce linear calibration curves over the range 1.25～70 ng?mL-1 of sirolimus in blood(r=0.999 7).The limit of detection was 0.5 ng?mL-1.Within the range,the average recovery rate was(101.7?2.7)% and the extraction recovery rate was≥82.8%.The coefficients of variation within a day and between days did not exceed 4.0% and 5.4%,respectively.CONCLUSION: This method is found to be easy,convenient and precise for fast monitoring of plasma concentration of sirolimus.

BACKGROUND:The immune cells of renal al ograft recipients have always been the hot spot of research. However, there are few studies addressing the immune cellsubsets in renal al ograft recipients before operation. OBJECTIVE:To investigate the proportional distribution of immune cellsubsets in renal al ograft recipients before operation. METHODS:Fifteen de novo living-related renal transplant recipients were enrol ed in this study with 15 healthy volunteers, aged 18-40 years, as healthy controls. Flow cytometry was employed to observe the proportion of the immune cellsubsets by extracting peripheral venous blood of al participants. RESULTS AND CONCLUSION:In the renal al ograft recipients, the proportions of CD4+CD25+T cells, the proportion of CD4+CD25+/CD4+T cells, CD19+B cells, CD19+CD5+B cells, CD19+CD27+B cells, NKG2A/NK cells, and NKG2A/NKG2 cells were al lower than those in the healthy controls;however, the proportion of CD38+IgD-/CD19+B cells and NKG2D cells were higher than those in the healthy controls. The difference of the proportion of immune cellsubsets aforementioned between the two groups was statistical y significant (P<0.05), while no difference was observed in other subsets. Immune cellsubsets in renal al ograft recipients before operation could be used to assess the immune status of the recipients, and also could be seen as the basal control for postoperative immunological monitoring.

Objective To discuss the value of CR and CT to diagnose early ankylosing spondylitis. Methods Clinical data and the signs of CR and CT of eighteen cases which were diagnosed as early ankylosing spondylitis were analyzed. Results Both CR and CT imaging could show the diseased region, morphous change, and the extent of diseased joint. CT imaging could show the tiny change of diseased articular facet. Conclusion CR plain is the first choice to diagnose early ankylosing spondylitis. As doubtful case, CR combination with CT scan can raise the accuracy rate of diagnosis to early ankylosing spondylitis.

Objective To study the influence of donor GFR on the early renal function in recipients undergoing living donor transplantation.Methods A total of 172 living donor transplant recipients in our kidney transplantation center from 2006 to 2011 were enrolled into this study.Among them,166 were genetically related (96.5％),while 6 were genetically unrelated (spouses in 5 and other in 1).The predonation GFR was measured by isotope clearance (99mTC-DTPA with few exceptions).The range of donor GFR was 62 to 148 ml/min.The recipients were classified into two groups according to donor graft GFR level (GFR≤45 ml/min,n=76; GFR＞45 ml/min,n =96).The predonation dialysis,cold and warm ischemia time,antibody induction,immunosuppressive regimens and HLA mismatch were not significantly different between two groups.Results There were no significant differences in the incidence of postoperative acute rejection and delay graft function (DGF).The postoperative Scr of GFR＞45 ml/min group in 1 week,1 month,3 months and 1 year was lower compared with the GFR ≤45 ml/min group,and only the difference of Scr in 1 week was significantly different (P＜0.05).A repeated-measure ANOVA revealed no significant differences were found in Scr variation of two groups during the first year after transplantation.Conclusions Predonation GFR of the donor has effect on the Scr of postoperative Ⅰ week of recipients,not on the Scr within a year.Recipients with graft GFR＞45 ml/min have lower Scr levels.

Mizoribine(MZR), as an orally prescribed immunosuppressive agent, has been applied in the prevention of rejection after kidney transplantation.MZR requires individual dosing due to the variation of bioavailability.However, therapeutic drug monitoring (TDM) of MZR is not well developed in China, as compared to other clinically used immunosuppressive agents.To our knowledge, this is the first TDM review of MZR.Pharmacokinetic characteristic, concentration determination methods and sample selection of MZR were summarized, also the rational therapeutic window was proposed.Furthermore, gene polymorphism and population pharmacokinetics of MZR were estimated.This review will provide reference for TDM-based individual dosing of MZR in renal transplant recipients.

Objective To establish a high-performance liquid chromatography method for simultaneous determination of mycophenolic acid(MPA) and its 7-O-glucuronide metabolite (MPAG) in human plasma and to study pharmacokinetics of MPA in Chinese renal transplant recipients after administration of mycophenolate mofetil( MMF). Methods Plasma protein was precipitated with metlianol: 5% ZnSO4 ( 70∶30, V∶ V), using naproxen as internal MPA and MPAG after 1.5g/d administration of MMF in 6 early-stage renal transplant recipients were as follows :Tmax was(1.08±0.74)h and(2.58±1.24)h,Cmax was(21.33±8.61)mg/L and(106.98±31.91)mg/L,AUCO-t was (58.73 ±16.26)mg ? L-1 ? h-1 and(833.32±215.03)mg ? L-1 ? h-1,respectively.Conclusion This method was accurate, sensitive and specific and it was successfully applied in therapeutic drug monitoring (TDM) of mycophenolate mofetil in early-stage renal transplant recipients.

[Objective]This study was designed to investigate capability of the conditioned media that originated from Renca cells to convert CIM~+ CD25~- T cells into CD4~+ CD25~+ T cells,which can exert immunosuppressive effect on effector T cells in vitro and in vivo.[Methods]The common media were mixed with the conditioned media at different ratios,and fresh enriched CD4~+ CD25~- T cells with MACS were cultured in mixed media for 7 days.At end-point of culture,the cells were collected and detected phenotypes in flow cytometer.Moreover,we detected immunosuppressive effect of converted CD4~+ CD25~+ T cells on effeetor T cells proliferation in one-way mixed lymphocytes reaction by using CCK-8,and we observed survival time and histology of grafts.The delayed type hypersensitivity was determined 14 days after transplantation.[Results]The mixed media could increase ratio of CD4~+ CD25~+ Foxp3~+ T cells in conditioned media ratio-dependent(P＜0.05),compared with control groups,when the mixed media contained no mote than 75% of conditioned media.The converted CD4~+ CD25~+ T cells significantly suppress proliferation of effector T cells in vitro,and prolong survival time of grafts,which were(29.6±1.4)d in converted CD4~+ CD25~+ T cells treated groups(P＜0.05),compared with that in untreated groups(9.8±0.6 d)or PBS treated groups(10.9±0.6 d).Moreover,delayed-type hypersensitivity reaction were conducted at day 14 after transplantation in the recipients,and the results showed that less pad swelling in the group treated with converted CD4~+ CD25~+ T cells than other control groups was found,according to measurement of pad swelling.In addition,progressed to complete necrosis of grafts were exhibited in the mice treated with PBS and untreated mice,whereas better healing of grafts and less lymphocytes infiltration were displayed in the mice treated with converted CD4~+ CD25~+ T cells,which were similar to the mice treated with natural regulatory T cells.[Conclusion]The converted CD4~+ CD25~+ T cells with Renca conditioned media play suppressive role in vitro and in vivo.

Objective To analyze the characteristics of extra-pulmonary tuberculosis in renal transplant recipients,and discuss its diagnosis and management. Methods From Jan.1991 to Apr.2007,37 cases of post-operational tuberculosis were identified out of the 2333 renal transplantations done in our center.Among them there were 19 cases with extra-pulmonary foci(51%),which involved allograft kidney in 5 cases,meninges in 4 cases,pleura in 4 cases,lymph node in 3 cases,soft issue in 2 cases,larynx,liver,vertebra and intestine in 1 case each.In 3 cases,there were 2 extrapulmonary sites involved at the same time.Most of the cases happened within one year post-transplant (53%).The most common clinical manifestation was fever. Results After anti-tuberculosis therapy,14 cases were cured and 5 were irresponsible and died.Eight cases (42%) experienced acute rejection and 4 cases(21%)had abnormal liver function during the treatment. Conclusions Extra-pulmonary tuberculosis had a high incidence and high mortality in post-renal-transplant population.Therefore,attention should be given to its differential diagnosis in clinical practice.Balancing anti-tuberculosis and anti-rejection therapy is important for this specific population.