Objective To evaluate the efficacy and safety of CsA substituted by tacrolimus(FK506) combined with MMF and prednisone in prevention of rejection in renal transplant recipents with hepatic dysfunction. Methods Eight patients with hepatic dysfunction received the treatment of FK506 substituting for CsA. FK506 was administeted at least 24 h after the last dose of cyclosporine.The initial dose of FK506 was based on body weight,the degree of hepatic dysfunetion and the period after operation of the patients.After administration of one week.the dose of FK506 was subsequently adjusted to maintain its whole blood trough levels between 5～15μg/L. Results Substitute of tacrolimus for cycbsporin resulted in a markedly reduced blood index,direct-bilirubin from(22.66±17.19)μmol/L to(7.05±2.32)μmol/L(P＜0.05), indirect-bilirubin from(42.15±34.15)μmol/L to(14.54±2.59)μmol/L(P＜0.05), sAL T from (83.00±93,14)IU/L to(29,50±15.41)IU/L(P＞0.05),Cr from (177.91±86.41)μmol/L to(135.92±34.05)μmol/L(P＞0.05)in one month.The ascites of 3 patients disappeared in one month. Astriction,anorexia,upper limbs trembling appeared only in one patient.Conclusion It is effective and safe to substitute CsA by FK506 combined with MMF and prednisone in prevention of rejection in renal transplant recipients with hepatic dvsfunction.

Objective To observe the effect of oxygen treatment plus non-invasive positive pressure ventilation on the stabillzation of chronic obstractive pulmonary disease and the influence on exercise tolerance.Methods The blood gas anylisis of and the result of 6 min walk test were observed and compared with self-control method.Results There was significant difference between the beginning and termination of the treatment in 10 patients haying finished the treatment and the results of 6 min walk test(P＜0.05).Conclusion The oxygen treatment plus non-invasive positive pressure ventilation in the stabilization of chronic obstructive pulmonary disease is safe and effective.

The disability and mortality of cerebrovascular diseases are high,and they cause significant harm to human health.A number of studies have found that a great many factors participated in the pathophysiological processes of cerebrovascular diseases including Rho-associated kinse.This article reviews the mechanisms of action on Rho-associated kinase in the pathophysiological processes of cerebrovascular diseases.

The severity of carotid atherosclerosis and the levels of serum matrix metalloproteinase-9(MMP-9)in patients with obstructive sleep apnea syndrome(OSAS)increase with the severity of apnea,and that MMP-9 plays an important role in the progression of carotid atherosclerosis.This article reviews the relationship between carotid atherosclerosis and serum MMP-9 so as to analyze the possible mechanism of developing carotid atherosclerosis in patients with OSAS.

Objective To evaluate two regimes of transient intensive insulin therapy in newly diagnosed type 2 diabetic patients with severe hyperglycemia.Methods Sixty-eight newly diagnosed type 2 diabetic patients with fasting plasma glucose(FPG)≥10.0 mmol/L and glycated hemoglobin A1c (HbA1c)≥8.0％were randomized to either cantinuous subcutaneous insulin infusion(CSII)group or multiple daily injection(MDI)group.Glycemic control,daily dose of insulin,body mass index(BMI),the mean area under the insulin curve(AUC),β-cell function(HOMA-β)and insulin resistence(HOMA-IR) were compared before and after treatment.Results There were no significant differences between two groups in days reaching glycemic control and BMI.The maximal insulin dose for glycemic control in CSII group was(0.53±0.06)U·kg-1·d-1 and that in MDI group was(0.71±0.04)U·kg-1·d-1(t= 11.100,P＜0.01).After CSII and MDI treatment,HOMA-β and the mean AUC of insulin were significantly increased(P＜0.01),but there was no significant difference between two groups(P＞0.05).No significant changes in HOMA-IR were observed before and after treatment or between two groups.There were no severe hypoglycemic episodes in two groups and mild hypoglycemic episodes were 0.34％(13/3806)in CSII group and 1.09％(44/4045)in MDI group.Conclusions The excellent glycemic control can be reached by short.terra CSII and MDI treatment in newly diagnosed type 2 diabetic patients with severe hyperglycemia.Lower insulin dose and less mild hypoglycemic episodes seem to be the advantage of CSII regime than MDI regime.β-cell function can be dramatically improved in both therapy regimes.

This paper reviews the development of physician professionalism and its research at home and abroad in recent decades.Content,evaluation,the problems and challenges,and the affecting factors of physician professionalism are analyzed.With regard to the status quo of physician professionalism in China,some ideas to improve and build physician professionalism in China are proposed.

BACKGROUND: A variety of cages for lumbar interbody fusion have been used, which have good mechanics and clinical effects. Conventional posterior fusion requires parallel implantation of two cages, but some researchers believe that single lumbar fusion cage in oblique way is also possible.OBJECTIVE: Through in vitro biomechanical tests, to find a method with favorable effect and little trauma by combination of percutaneous lateral oblique way into the single expansive lumbar fusion cage between the fixed-line operations.DESIGN, TIME AND SETTING: A randomized, controlled experiment was performed at the Shanghai Institute of Biomechanical Engineering between May 2005 and May 2008.MATERIALS: Expansile lumbar interbody fusion cage was simulated from B-Twin Cage (Disc-O-Tech, Israel). Fresh calf lumbar specimens were used.METHODS: Biomechanical tests were performed in 18 specimens of calf lumbar function spinal units (FSU), which were divided into 3 groups: 6 in control group, 6 in single cage groups and 6 in two-cage groups. The biomechanical tests of two experimental groups were performed following tests of intact specimens. Stiffness tests were conducted in the WE-10A MTS,including axial compression, flexion, extension, lateral bending, and torsion.MAIN OUTCOME MEASURES: Axial and torsion stiffness results of each group.RESULTS: The stiffness was greater in two-cage groups compared with single cage group in axial compression and extension, but significant differences were only found in axial compression and extension tests (P < 0.05). The torsion stiffness of single cage group was significantly greater than two-cage groups (P < 0.05).CONCLUSION: Percutanous lumbar interbody fusion by single expansile lumbar interbody fusion cage from lateral approach is feasible theoretically. Biomechanical properties of FSU with B-Twin cage are improved, which contributes a lot to lumbar stability. Compared with posterior approach of single cage, two-cage can provide better stiffness and stability but its torsion stability is lower.

Based on literature review, questionnaire survey, Interact investigation, experts interview and seminars the paper analyzes the status quo of the information literacy education and existing problems in traditional Chinese medicine colleges and universities, proposes constructive advices on carrying out information literacy education, moreover, provides a information literacy education standard for traditional Chinese medical colleges and universities and initially constructs a comprehensive information literacy education system.

Cyclin E is expressed starting from the middle G1 phase of the cell cycle,and is accumulated in the G1/S boundry.Cyclin E binds to and activates the cyclin-dependent kinase CDK2.Cyclin E-CDK2 complex initiates a cascade of events that leads to DNA replication by phosphorylating its substrates,such as Rb,CDC6,NPAT and P107,etc.Additionally,cyclin E plays an important role in the regulation of genomic stability,spindle-organizing structure and centrosome cycle.Cyclin E expression is trans-activated by members of the transcription factor E2F family and degrades via the ubiquitin-proteasome pathway.At the same time,it is also negatively regulated by the CIP/KIP proteins.Cyclin E highly expressed in the initiation and progression of different human cancers,such as breast cancers,lung cancers,leukemia,lymphomas and others.

Although natural orifice transluminal endoscopic surgery provides excellent cosmesis,it is not being widely accepted because of the restriction in aspects of technology,instruments and ethics.As a bridge,laparoendoscopic single site surgery(LESS)has been widely applied in digestive surgery,including bariatric,gastric,hepatobiliary and colorectal surgery.Although LESS provides excellent cosmetic results,and its safety and feasibility seems similar to conventional laparoscopy in most procedures,its effectiveness in the treatment of malignant tumors still needs to be proved. Compared with conventional laparoscopy,LESS has the drawbacks of longer operation time and higher demand in experience.Besides,because digestive tract reconstruction is often needed after resection,more convenient and applicable instruments need to be invented for the development of LESS.