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.

Biopsy ; methods ; Drainage ; Humans ; Jaundice, Obstructive ; etiology ; therapy ; Lymph Node Excision ; methods ; Neoplasm Staging ; Pancreatic Neoplasms ; complications ; diagnosis ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Salvage Therapy

Vasovagal syncope (VVS)is the most common clinical unexplained syncope,and its pathogenesis has not been fully understood yet.The contradictory reflection of cardiac autonomic nervous system caused by riggerring Bezold-Jarisch reflex,which could cause dilated blood vessels,blood pressure and cardiac output decreased,insufficient blood supply to the brain relate with syncope occurrence.Currently,most people consider it mainly relatel to the age and gender of patients,history of syncope,family history,mental and psychological factors,dietary habits and other factors,but the exact risk factors of VVS remains further study of multi-center and a large sample of data.

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.

To evaluate the effects of diltiazem hydrochloride (D) and verapamil (V) on hypertensive left ventricular (LV) diastolic function, the measurement of pulsed Doppler transmittal inflow was performed in 44 patients (22 cases in each group) before, and at 3 h and 7 h after single large dose. Sixteen patients of D group and 11 of V group received routine dose for one month. The Doppler diastolic function indexes included EDC EV/AV, EA/TA AA/TA and 1/3 FFd. The result showed that blood pressure was reduced to the same level in two groups, but improvement of LV diastolic function was more significant in D group. It is concluded that two calcium antagonists can improvement of LV diastolic function after single large dose, but improvement of LV diastolic function is not completely related to reduction of Hood pressure. After one month, since D can reduce Wood pressure and improve mycardial ischemia more markedly than V, and the negative inotropic effect is lower than V, D is superior to V in improving LV diastolie function

Ectodermal Dysplasia ; classification ; diagnosis ; Humans ; Infant ; Male ; Patient Care

In order to explore the effect and mechanisms of tumor necrosis factor-alpha (TNF-alpha) on the activity of the acyl coenzyme A: cholesteryl acyltransferase (ACAT), THP-1 monocytes were cultured and induced to differentiate into macrophages with phorbol ester. TNF-alpha (60 ng/mL) was added at different time points into the macrophage-containing medium and the ACAT enzyme activity was measured by quantifying the incorporation of [1-(14)C] oleoyl CoA into cholesteryl esters. The expression of ACAT-1 protein and mRNA was respectively detected by Western blotting and RT-PCR in THP-1 macrophages 24 h after treatment with TNF-alpha (60 ng/mL). The results indicated that ACAT activity in THP-1 macrophages treated with TNF-alpha was increased in a time-dependent manner. The expression levels of ACAT-1 protein and mRNA were significantly increased in THP-1 macrophages after treatment with TNF-alpha (P<0.05). It was suggested that TNF-alpha could increase the activity of ACAT in THP-1 macrophages by up-regulating the expression of ACAT-1 gene.

OBJECTIVE To explore the features,developing trend and factors of hospital infection in patients with iatrogenic injury.METHODS Retrospective surveys of hospital infections in 750 cases with iatrogenic injury were carried out in hospital between 2000 and 2007.RESULTS The incidence of hospital infection in patients with iatrogenic injury was 87.39%.Among them,hospital wound infection was the highest(87.39%),the second one was cavity infection(8.98%).The leading causative microorganisms were Gram-negative bacteria.CONCLUSIONS It is imperative to make effort to decvease the morbidity of hospital infections.We hope that the iatrogenic injury can be brought into the category of public health as soon as possible to enhance the medical care service and secure safty and health of the patients.

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.

AIM：To study the effects of citicoline in treating neuroleptic-induced extrapyramidal side effect (EPS)．　METHODS：Seventy-five patients were divided into two groups：citicoline group of 38 patients ( M25，F13；age 28 a±s 9 a) received citicoline injection 0.5 g.d-1，in 5 % glucose injection 500 mL，iv，drip，qd ，for 14 d and control group of 37 patients ( M23，F14；age 27 a±6 a) received 5 % glucose injection 500 mL，iv, drip, qd，for 14 d．　RESULTS: The total efficacy of citicoline or control group was 92 % and 11 % (P＜0.05 ), respectively．The tremour, muscular rigidity, gait and muscle dystonia were better in citicoline group than in control group. No side effects were found. 　CONCLUSION: Citicoline is effective for neuroleptic-induced EPS.