OBJECTIVE: To evaluate the efficacy and safety of tacrolimus (FK506) instead of cyclosporine (CsA) in renal transplant recipients with hepatic impairment. METHODS: Eighteen patients with hepatic impairment, including 10 male and 8 females, aged 19-68 years (mean aged 40 years), 2 out of them suffered diabetes mellitus, 1 of them had hepatitis B prior to operation. After operation, all patients were treated with CsA 6 mg/(kg?d), the mass concentration was changed from 250-400 ?g/L at 1 month after operation to 250 ?g/L after half year. Totally 30 mg/d prednisone was used at first and changed to 20 mg/d at 1 month after operation. Mycophenolate was applied with 1.5 g/d, or azothioprine 50-100 mg/d. FK506 was used instead of CsA when alanine aminotransferase was over 1 500 nkat/L, with over 25.1 ?mol/L bilirubin direct. The initial dose of FK506 was 0.1 mg/(kg?d) at the second day after drug withdrawal and adjusted to base on its blood trough levels and the degree of hepatic impairment. The dosage of mycophenolate or prednisone was invariably. RESULTS: Hepatic function and bilirubin metabolism of all patients were returned to normal leverl without reject reaction in 15-60 days. One patient, who had severe hepatic impairment, was recovered in 46 days. Five patients had high blood sugar levels, and one had high blood cholesterol. After hypoglycemic and cholesterol lowering therapy, the blood glucose was controlled below 7.5 mmol/L from at the beginning of (16.7?2.8) mmol/L, and the blood fat was kept in a normal level. CONCLUSION: FK506 substituting for CsA can recover hepatic function with high safety in recipients with hepatic impairment.

Objective To analyze the practical experiences of design and its clinical application of custom-made tumor prostheses of knee. Methods A retrospective study of 41 cases of distal femur or proximal tibia tumors treated surgically from June 1999 to October 2002, was carried out. In the study, there were 29 males and 12 females aging from 11 to 69 years with an average of 35.0 years. The location of tumors were at distal femur in 23 cases and 9 cases at proximal tibia, of which 15 were osteosarcoma, 13 giant cell tumor, 3 chondrosarcoma, 5 solitary metastatic bone tumor, and 1 each of fibrosarcoma, malignant fibrohistocytoma, Ewings sarcoma, small round cell sarcoma and syndesmofibroma. The custom-made semi-constrained knee prosthesis with femoral or tibial component was implanted after extra-capsular resection of the tumor bone segment. A special femoral component with elongated construction was used in an 11-year old case for further femur lengthening. Resection of femoral artery involved by tumor and reparation by great saphenous vein was performed in one case. Results The operations of the 41 cases were all smoothly performed. 33 cases were followed up from 8 to 37 months with an average of 20.2 months. The daily life ability was recovered in 3 months after the operation. Among them, no loosening or failure of the prostheses was found, and local recurrence was found in 2 cases and distant metastasis in 3 cases. The design of knee prosthesis could provide some proper internal/external rotation and adduction/abduction movements accompanying with the flexion and extension of the knee joint without affecting the stability of the joint. For the case of proximal tibia tumor, a special design and surgical technique was developed to provide the reconstruction of patellar ligament insertion with rather good results; and the recovery of knee extension and stability were satisfied. Conclusion The custom-made semi-constrained tumor prosthesis of knee could be used as an effective method for the limb-savage management either the distal femur or proximal tibia tumor cases.

Ovbective To evaluate the role of electron beam computed tomography (EBCT) in diagnosis of anomalous pulmonary venous connection. Methods Retrospective analysis on 20 cases diagnosed as anomalous pulmonary venous connection by EBCT. The slice thickness and scan time was 1.5～3mm and 100ms respectively. 3～4ml/s non-ionic contrast medium was injected. Three-dimensional reconstruction of EBCT images was carried out in all cases with special workstation. Meanwhile,ultrasound echocardiography was performed on all patients and conventional cardiovascular angiography was performed on 10 patients as control. 14 cases were operated. Results (1) 4 patients with total anomalous pulmonary venous connection and 16 patients with partial pulmonary venous connection were diagnosed by EBCT preoperatively. (2) Compared with the findings from operations (14 cases),CT results (14 cases) corresponded well in 13 cases and corresponded partially in other 1 case. Meanwhile,ultrasound echocardiography (14 cases) only corresponded partially in 2 case and suggested suspected APVC (without any exact number and connective location of APVC were mentioned) in other 8 cases. Cardiovascular angiography was performed in 6 of 14 cases and APVC was found in 4 of them. (3) In 6 non-operation cases,four underwent conventional cardiovascular angiography. APVC were diagnosed in 2 only of these 4 cases. Meanwhile,the diagnoses of these 6 cases were all confirmed by CT ultrasound,echocardiography didn't yield positive findings of APVC. Conclusion EBCT might be significantly superior to UCG and angiography in the detection of anomalous pulmonary venous connection. According to our experience,EBCT with 3-D reconstruction was a noninvasive,effective method in the diagnosis of APVC.

Objective To study the time course of effect of methylene blue on inducible nitric oxide synthase (iNOS) mRNA transcription and protein expression in lung tissue of rats with sepsis, and its mechanism. Methods 126 female Wistar rats were randomly divided into sham group, sepsis group and methylene blue group. Each group was subdivided into 0-, 6-, 12-, 18-, 24-, 30-, and 36-hour subgroups according to the time after operation, with 6 rats in each subgroup. A model of sepsis was reproduced by cecal ligation and puncture (CLP), and the rats in sham group were only opened the abdominal cavity and isolated the membrane of the appendix without CLP. Rats in methylene blue group were given injection of 15 mg/kg methylene blue at all time points after CLP, the remaining rats were given 0.9%NaCl solution in same amount. Six hours after the injection, the rats were sacrificed and the lung tissue was harvested immediately. The expression of iNOS mRNA and protein in lung tissues were determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and Western Blot respectively, and the changes in histopathology were observed using hematoxylin and eosin (HE) staining. Results Compared with sham group, the expression of iNOS mRNA was significantly up-regulated at 6, 12, 18 and 24 hours after CLP in sepsis group (2-ΔΔCt: 2.42±0.66 vs. 1.00±0.38 at 6 hours, P = 0.002; 2.54±0.76 vs. 1.00±0.27 at 12 hours, P = 0.000; 5.46±2.26 vs. 1.00±0.38 at 18 hours, P = 0.000; 3.03±0.62 vs. 1.00±0.33 at 24 hours, P = 0.001), and iNOS protein expression was significantly up-regulated at 12, 18 and 24 hours (gray value: 2.54±0.45 vs. 1.00±0.35 at 12 hours, P = 0.000; 2.65±0.64 vs. 1.00±0.33 at 18 hours, P = 0.000; 3.03±0.59 vs. 1.00±0.24 at 24 hours, P = 0.000). Compared with sepsis group, the expression of iNOS mRNA was significantly down-regulated at 6, 12, 18 and 24 hours in methylene blue group (2-ΔΔCt: 1.55±0.82 vs. 2.42±0.66 at 6 hours, P = 0.034; 1.84±0.42 vs. 2.54±0.76 at 12 hours, P = 0.016; 2.66±1.09 vs. 5.46±2.26 at 18 hours, P = 0.003; 2.20±0.29 vs. 3.03±0.62 at 24 hours, P = 0.002), and iNOS protein expression was significantly lowered at 12, 18 and 24 hours (gray value: 1.84±0.18 vs. 2.54±0.45 at 12 hours, P = 0.003; 1.87±0.27 vs. 2.65±0.64 at 18 hours, P = 0.008; 2.20±0.50 vs. 3.03±0.59 at 24 hours, P = 0.008). Histopathological observation showed that the degree of lung injury at each time point, including red blood cells effusion, lung interstitial edema, inflammatory cell infiltration, alveolar collapse etc., in sepsis group and methylene blue group were significantly higher than that of sham group, and the degree of lung injury in rats with methylene blue was not significantly improved as compared with that of sepsis group. Conclusions Lung iNOS mRNA expression was significantly increased at 6-24 hours after CLP induced sepsis in rat, and protein expression was increased at 12-24 hours. Methylene blue could inhibit mRNA transcription and protein expression of iNOS in lung of septic rat, but failed to reduce the degree of lung injury in sepsis.

[Objective]To observe expression of inducible nitric oxide synthase and peroxynitrite anion around the prostheses,and study the relationship between the osteolysis and inducible nitric oxide synthase peroxyni-trite.[Method]Interface tissues were obtained at three Delee-Charnley acetabular sections and seven Gruen femur sections in six revision total hip arthroplasty surgery. The tissues were prepared for immunohistochemical assays to determine the expression of iNOS and nit rotyrosine (NT)-a specific“footprint”of peroxynitrite. Pre-revision X-ray films were observed to determine the incidence of osteolysis regions and non-osteolysis regions. The correlation between the positive cells and the severity of osteolysis were analyzed and compared.[Result]Data showed that zone Ⅲ has much higher iNOS positive immunostaining than that of zone Ⅰ and Ⅱ at acetabulum, and the expression of zone 1、2、6、7 was significantly higher than the other zone at femur(P

[Objective]To observe the change of children necrotic femoral head repairing under low stress environment and to explore the effect of low stress environment on Perthes disease.[Method]The sick coxa was supported by Coxa Multi-functional External Fixation Shoring Fixator,which decreased femoral head stress and creates a low-stress environment for the sick coxa.Meanwhile,the affected extremity was kept abduction and internal rotation in order to increase femoral head containment.The coxa could flex and extend partly on sagittal plane.Twenty-eight patients(32 hips) were followed up with mean follow-up time of 3 years and 5 months(2~7 years).The radiological characteristics of pre-and post-operation was analyzed.[Result]At 3 months postoperatively,joint space was broadened,high density necrosis shadow became little and little,the femoral head became full,height of the femoral head epiphysis increased.If epiphyseal nucleus fragmentation vaded epiphyseal plate,the big head and pachy-neck and the subluxation of coxa would finally result.[Conclusion]Under low stress environment,child necrotic femoral head could be repaired.The prognosis is related to Catterall stage of Perthes disease.On Catterall Ⅱ and Ⅲ stage,the curative effect is fairly good.But on Catterall Ⅳ stage,the curative effect is not evident.

[Objective] To compare the expression of matrix metalloproteinase 2(MMP-2)and matrix metalloproteinase 9(MMP-9)induced by alumina and ultra-high-molecular-weight polyethylene(UHMWPE)wear particles,and investigate the role of MMP-2 and MMP-9 in the mechanism of the periprosthetic osteolysis induced by wear debris during aseptic loosening.[Methods]Seventy-two Kunmin mice were divided into 3 groups(24 per group)in a murine air pouch model of inflammation.The air pouches were injected with 3ml of suspension containing 1?108 /ml alumina particles in group A,while UHMWPE particles in group B,and control pouches received 3ml of sterile PBS.All animals were sacrificed at 3、7、14 days after injection.Histological changes and cell counting were assessed by light microscope.RT-PCR and immunohistochemistry method were applied to detect the gene and protein expression of MMP-2 and MMP-9 in the pouches.[Results]Increased cell infiltration and MMP-2,MMP-9 mRNA and immunoreactivity expression were detected in group A and B,and compared to control group,cell number and gene and protein expression of MMP-2 and MMP-9 in group A and B was significantly higher(P

[Objective]To investigate a method of in vitro preparation and separation for metallic wear particles around joint prosthesis,and evaluate its feasibility in medical experiments of prosthetic loosening.[Method]Metallic wear particles were made around joint prosthesis by vacuum ball mill in vitro.Particle size,size distribution,chemical composition and shape were characterized by element trace analysis,laser countersizer,scanning electron microscopy.Metal particles were co-cultured with RAW264.7 cells,and its cytotoxicity was detected.[Result]Metal particles made by vacuum ball mill in vitro was similar to particles extracted in vivo(

Objective To investigate the aberrant expression of phosphoproteome analysis of peripheral blood mononuclear cells( PBMCs) in patients with systemic lupus erythematosus( SLE) . Lay the foundation for further re-search of mechanism and treatment in patients with SLE. Methods Phosphopeptides were enriched using TiO2 from PBMCs of patients and healthy subjects, then analyzed by automated LC-MS/MS analysis. Phosphorylation sites were identified and quantitated by MASCOT and MaxQuant. Differential expressed proteins and peptides were screened based on the bioinformatics analysis. Results 1 035 phosphorylation sites were identified from SLE com-prared with normal subjects, 618 corresponding genes were screened out in annotation proteins. Pathway analyses showed 12 signaling pathways were identified. There were the most difference phosphorylation sites in mitogen acti-vated protein kinases( MAPK) signaling pathway. Conclusion Differently phosphorylated proteins and peptides can be detected in patients with SLE, which can be used as a mechanism of reference and supplement combined with metabolic pathway, and might be used as a potential target for treatment and research of SLE.

Objective To evaluate the middle-term effect of laparoscopic uterine artery occlusion combined with ascendant myomectomy (LUAO-M) for multiple uterine myomas. Methods The uterine artery was isolated and occluded with Kleppinger bipolar forceps (Sabre 2400,ASPEN LABS USA) or PK forceps (Gyrus Medical Limited Inc UK) under a laparoscope. Then dissection was performed on the surface of pseudo capsule with Kleppinger unipolar needle (Sabre 2400,ASPEN LABS USA) or PK needle (Gyrus Medical Limited Inc UK),and the target myoma was stripped out of the tumor bed with the Separate-Scoop device. Afterwards,repair of the incision was carried out in one layer with interrupted single stitch by Absorbable VICRYL suture (Johnson VICRYL ETHICON USA). Results The mean operation time was (102?36) min and mean blood loss was (88.7?58.4) ml. The mean hospital stay after the operation was (7.9?0.2) d,and febrile morbidity was 5.1% (5/98). Complications included two cases of subcutaneous emphysema and one case of ileus;no other severe complications occurred. Of the patients,98 cases were followed-up for 21 to 52 months (mean,36.3 months),during the period they were visited by a mean of 3.6 times,which showed a correction rate of menstruation abnormality of 95.9% (4/98),rate of uterine volume reduction of 57.7%,and rate of recurrent myoma of 3.1% (3/98). Conclusion LUAO-M shows a good clinical outcome and middle-term effect for multiple uterine myomas.