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 study the effectiveness of the complete ureterel reconstruction using bladder flap after cadaveric renal transplantaion.Methods In 13 recipients with complete necrosis of ureter after renal transplant from July 1995 to October 2003, tubelike bladder flaps were applied to ureteraplasty substitute for the necrosis ureter. Artificial pyeloureterostomy was performed and double T tubes were used as the stents. Routine drainage-tubes were placed in incisions. Results All patients were successful in ureteral reconstruction. The renal function of 10 patients was improved significantly 4 weeks postoperation. Nephrectomy was performed in one patient because of severe circumrenal infection 7 days after operation. One-year survival rate of recipients and allografts was ~100 % (13/13) and ~92.3 % (10/13) respectively. Urine reflow occurred in 2 patients during a follow-up of 12 months. Conclusion The use of bladder flap for ureteral reconstruction is an effective technique for total autograft ureteral necrosis.

BACKGROUND: Using color Doppler ultrasonography, renal graft size, appearance, structure, and blood flow distribution can be observed. Through the use of blood flow display technique, blood flow perfusion of renal graft can be accurately observed to assist diagnosis and differential diagnosis of complications following renal transplantation. OBJECTIVE: To observe the hemodynamic characteristics during different periods of acute renal transplant rejection, summarize its specific manifestations through analyzing different reaction of two dimensional and color Doppler flow imaging (CDFI) during renal transplantation in order to get valuable index on acute rejection of renal transplantation.DESIGN, TIME AND SETTING: Comparative observation was performed at the Jinan University and First Hospital of Shenzhen University between January 2003 and January 2007.PARTICIPANTS: A total of 299 patients undergoing renal transplantation were divided into normal allograft group (n=236) and acute rejection group (n=63) according to renal allograft function.METHODS: The systolic peak flow rate, end-diastolic flow rate, mean flow rate, pulsatility index and resistance index of main renal artery and arcuate artery in patients of two groups were compared. MAIN OUTCOME MEASURES: Renal allograft arterial inner diameter and hemodynamics of two groups.RESULTS: Compared with normal allograft group, the blood flow perfusion was reduced at acute rejection, which could not reach cortex margin, blood velocity was decreased at the diastolic phase, pulsatility index and resistance index were increased (P < 0.05). CONCLUSION: Color Doppler ultrasound, as a convenient, economical and noninvasive technique, provides the reliable evidences for the renal artery pulsatility index and resistance index in clinic, and also is valuable for the acute rejection early diagnosis of renal allograft.

In order to construct a eukaryotic co-expression plasmid containing membrane-anchored Sjcl4FABP and Sjc26GST genes and identify their expression in vitro, Sj14 and Sj26 genes were obtained by RT-PCR with total RNA of Schistosoma japonicum adult worms as the template and cloned into eukaryotic expression plasmid pVAC to construct recombinant plasmids pVAC-Sj14 and pVAC-Sj26. Then a 23 amino-acid signal peptide of human interleukin-2 (IL-2) upstream Sj14 or Sj26 gene and a membrane-anchored sequence containing 32 amino-acids of carboxyl-terminal of human placental alkaline phosphatase (PLAP) downstream were amplified by PCR as the template of plasmid pVAC-Sj14 or pVAC-Sj26 only to get two gene fragments including Sj14 gene and Sj26 gene. The two modified genes were altogether cloned into a eukaryotic co-expression plasmid pIRES, resulting in another new recombinant plasmid pIRES-Sj26-Sj14. The expression of Sj14 and Sj26 genes was detected by RT-PCR and indirect immunofluorescent assays (IFA) when the plasmid pIRES-Sj26-Sj14 was transfected into eukaryotic Hela cells. Restriction enzyme analysis, PCR and sequencing results revealed that the recombinant plasmids pVAC-Sj14, pVAC-Sj26 and plRES-Sj26-Sj14 were successfully constructed and the expression of modified Sj14 and Sj26 genes could be detected by RT-PCR and IFA. A bivalent membrane-anchored DNA vaccine encoding Sj14 and Sj26 genes was acquired and expressed proteins were proved to be mostly anchored in cellular membranes.

BACKGROUND: Similar to other prosthesis, metal-metal prosthesis would produce plenty of wear particles and metal ions, mainly presented as cobalt (Co~(2+)) and chromium (Cr~(3+)), which can lead to osteolysis, eventually, result in aseptic loosening. OBJECTIVE: To observe the effect of Co~(2+) and Cr~(3+) ions on the cells viability and expression of RANK in rats m0nocyte-macrophage cells (RAW264.7) in vitro. METHODS: Monocyte-macrophage cells (RAW264.7) were cultured in vitro, and then the cells were exposed to Co~(2+) and Cr~(3+) ions. The cell viability was assured by MTT test and the level of RANK Mrna was detected by semi-quantitative RT-PCR at different times. RESULTS AND CONCLUSION: Compared to the control group, MTT test demonstrated that Co~(2+) and Cr~(3+)ions could decrease the cell activity of monocyte-macrophage cells obviously. When the cells were exposed to Co~(2+) Cr~(3+) ions, compared to the control group, the Mrna expression of RANK of the metal ions group was increased at 12 hours (P < 0.05), reached its peak level at 24 hours (P < 0.05), and decreased at 48 hours than that of 24 hours (P < 0.05). The results revealed that metal ions have a cytotoxic effect on monocyte-macrophage cells, stimulate the expression of RANK, and have the potential of facilitating monocyte-macrophages cells transform into osteoclast-like cells.

OBJECTIVETo analyze the incidence and treatment of Clostridium difficile infection (CDI) in pediatric patients with antibiotic-associated diarrhea (AAD).

METHODClinical data of totally 577 pediatric patients with AAD seen from January 2012 to January 2014 were collected; those children were divided according to age into 4 groups, 0.25 -1 year, >1 -4 years, >4 -12 years and >12 -18 years old groups, and 220 healthy children were enrolled as controls. CDI was tested by C. Diff Quik Chek Complete (QCC) and BD GeneOhm™ C. Diff Assay (BD-PCR) in all children, and the CDI incidence of four groups was added up. All pediatric patients with AAD were divided into mild, general and severe type according to different symptoms of diarrhea, and grading treatment, the general type and severe type of CDI children were treated with metronidazole and (or) vancomycin, afterwards, the results of grading treatment were analyzed.

RESULTThe number of pediatric patients with AAD were 178, 177, 132 and 90 in 0. 25 - 1 year, > 1 -4 years, > 4 - 12 years and > 12 - 18 years old group, respectively. The positive rate of CDI (22. 0% (39/177)) in > 1 -4 years old AAD patients was very significantly higher compared to the controls (4% (4/91), P < 0. 001), the rate of CDI (21. 2% (28/132)) in > 4 - 12 years old AAD pediatric patients was significantly higher compared to the controls (4% (2/53), P = 0. 004), the rates of CDI in 0. 25 - 1 year and > 12 - 18years old AAD groups were not significantly different from that of the controls (P >0. 05). There were 285 mild type AAD children (no CDI children), 176 general type AAD children (including 47 CDI children), and 116 severe type AAD children (including 81 CDI children). After grading and symptomatic treatment, there were 16 recurrent diarrhea in 128 CDI patients (severe type AAD), and the rest recovered. Two cases were transferred for referral treatment, 2 cases died, and the rest 12 recurrent diarrhea children fully recovered after administration of metronidazole, vancomycin, probiotics and symptomatic treatment.

CONCLUSIONThe > 1 -12 years old AAD children had higher CDI rate than healthy children; administration of metronidazole and (or) vancomycin was effective for CD infection.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Case-Control Studies ; Child ; Child, Preschool ; Clostridium Infections ; drug therapy ; Clostridium difficile ; Diarrhea ; microbiology ; Humans ; Incidence ; Metronidazole ; therapeutic use ; Probiotics ; therapeutic use ; Vancomycin ; therapeutic use

AIM To study the effects of ternatolide(tern) on expression of granulysin mRNA in the activated peripheral blood lymphocytes(PBLS) of the adults and children with pulmonary Mycobacterium tuberculosis(PMTB). METHODS Using competitive quantitative reverse transcription polymerase chain reaction(QC TR PCR)analyze granulysin gene expression in the PBLs. RESULTS The dosage of 100 mg?L -1 , 200mg?L -1 of ternatolide significantly enhanced the granulysin mRNA experession in PBLs in vitro stimulated phytohemagglutinin (PHA) from adults and children with PMTB (P0 05). CONCLUSION The molecular mechanism of tern. against intracellular pathogens might be associated with the inducting highly level on the expression of granulysin mRNA, a anti bacterial peptide in activated human cytotoxic lymphocytes.

Objective To evaluate the application value of X-ray,echocardiogram,pulmonary perfusion scintigraphy,EBCT,Magnetic resonance Pulmonary angiography in diagnosis of PTE.Methods Twenty-five consecutive patients clinically diagnosed of having PTE were examined from july 2003 through March 2004. Patients underwent X-ray chest plain film, echoeardiogram, electronic beam computed tomographie (EBCT)angiography,ventilation-perfusion (V-P)seintigraphy,Magnetic resonance Pulmonary angiography (MRPA)and puhnonary angiography according to a strict diagnostic protocol.Two of the independent readers reviewed the pulmonary angiography and record all of the lobe and segmental involved in PTE and compared with other image method.Results Pulmonary angiography:all of the patients success underwent the technique,the pulmonary artery branch with PTE was in 556 of 775 branches (71.7%). Chest radiography had hints of diagnosis in 12 of 25 patients.Nine patients diagnosed with echocardiogram. Right heart enlargement was in 21,and pulmonary hypertension in 18.V-P scintigraphy revealed 247 segmental involved with PTE of 500 (52.0% ),and the sensitivity was 64.66% compare with the pulmonary angiography.There were 523 pulmonary branches involved PTE with EBCT pulmonary angiograpy of 775 branches,and the sensitivity was 94.06%.MRPA: 8 of 10 patients succeed in the technique, 155 branches of 248 were detected with PTE(62.5% ),the sensitivity was 81.29%.Conclusions EBCT is a high sensitivity method in diagnosis of PTE.Chest radiography and echocardiogram are the first-line modality of PTE.V-P scintigrapby is the valid compensation in diagnosis subsegmental pulmonary artery with PTE when EBCT miss diagnosis.Gd-CE-MRPA may be the second-line modality in diagnosis of PTE.

To further explore the result of bilingual teaching in pediatrics,we randomly chose 200 undergraduates of 4 class and released students'questionnaires about bilingual teaching with teaching content before and after class to assess students'understanding of bilingual teaching and analysed appraisal result.We found no significant difference of student score between students accepting bilingual teaching and not accepting the bilingual teaching,but there was difference for English tests and expression level.So we think that students can fully accept the bilingual teaching of pediatrics under the premise with selecting appropriate teaching methods and means.

Objective To investigate the effect of median nerve electrical stimulation on the activity, speech and quality of life in patients after severe traumatic brain injury. Methods 60 patients with severe traumatic brain injury were divided into 2 groups: the control group (A) and the treated group (B). The patients in Group A were treated with the routine medicine and rehabilitation. Based on the routine therapy, the patients in Group B were treated with the right median nerve electrical stimulation. Their outcome, activity, speech and quality of life were assessed. Results The scores of Glasgow Outcome Scale (GOS), speech assessment, and the quality of life in Group B improved compared with that in Group A (P<0.05), the activity seemed to improve, but not significantly. Conclusion The right median nerve electrical stimulation is effective to promote the recovery of neurological function and improve the quality of life in patients with severe traumatic brain injury.