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.

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.

[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 evaluate the clinical effect and safety of Levofloxacin(LVFX)in the treatment of the old pa?tients with lower respiratory tract infections.METHODS:Sixty-six old patients with lower respiratory tract infections were randomly divided into trial therapy group and the control group,receiving0.4g LVFX and0.4g Ofloxacin intravenous drip once a day for7～14days respectively.RESULTS:In the trial therapy group and the control group,the clinical effective rates were90.9%and66.7%(P0.05),adverse reaction rates were9.1%and33.3%(P

Objective To select the intravenous anesthetic with less effects on the erythrocyte immunity,and observe regulation of ?-endorphin on erythrocyte immunity in vivo Methods Seventy-two mice were randomly allocated to receiving intraperitoneally normal saline 0 04ml/g (group I,n=13), thiopental sodium 60mg/kg (groupⅡ,n=10),etomidate 20mg/kg (groupⅢ,n=10),etomidate -lipuro12mg/kg (groupⅣ n=9), midazolam 20mg/kg (groupⅤ,n=12),fentanyl 100?g/kg (groupⅥ,n=10) or pethidine 20mg/kg (groupⅦ,n=10) at 9 o'clock in the morning ,respectively and were administered at half dosage at 3 o'clock in the afternoon At 9 o'clock of the next day.Results Compared with those in group Ⅰ, the rosette rate of RBC-C3b receptor(RC3bRR) decreased significantly in group Ⅱ, Ⅳ,Ⅴ and Ⅶ(P

AIM: To comparatively analyze the pain related factors levels and therapeutic response in patients treated with ~(99)Tc-MDP and ~(153)Sm-EDTMP for painful skeletal metastases. METHODS: Plasma endothelin (ET), calcitonin gene-related peptide (CGRP), thromboxane B_2 (TXB_2) and 6-keto-prostaglandin F_ 1? (6-k-PGF_ 1? ) levels were analyzed in 93 patients with painful skeletal metastases prior and 3 months after treatment. 55 cases were just treated with 153 Sm-EDTMP (group A); 19 cases were treated only with 99 Tc-MDP (group B); and 19 cases were treated with both 153 Sm-EDTMP and 99 Tc -MDP (group C). RESULTS: 69.1 %, 73.7 % and 89.5 % of the patients were experienced pain relief 3 months after treatment in groups A, B and C, respectively. Comparative analysis shows that: ET and 6-k-PGF_ 1? levels increased significantly 3 months after treatment in all patients (P