AIM:Anti-hepatis B immunoglobulin in combination with lamivudine is efficient to prevent chronic hepatitis B virus (HBV) reinfection following liver transplantation. However, long-term usage of lamivudine can result in YMDD variation and lead to medicine resistance even HBV relapse. In this study, we investigated etiological factors and prevention and treatment protocol of HBV recurrence and YMDD variation after liver transplantation. METHODS:A computer-based online search of Pubmed database from January 2002 to January 2008 and Chinese Journal Full-text Database from January 2003 and December 2007 was undertaken to identify articles about HBV recurrence and YMDD variation after liver transplantation. The collected articles were firstly selected and the references of each article were looked up. Only articles that involved in HBV recurrence and YMDD variation after liver transplantation were included. The articles published in authoritative journals in recent 5 years were accepted in priority. Repetitive articles and Meta analysis were excluded. RESULTS:HBV recurrence after liver transplantation is associated with hepatitis B DNA loading dose, invasion of hepatitis B into non-liver tissues, immunosuppressive therapy and viral genovariation. The major prevention and treatment protocol of HBV reinfection after liver transplantation is the combination of anti-hepatis B immunoglobulin and lamivudine, which is economical and efficient. However, long-term administration of lamivudine induces YMDD variation in hepatitis B DNA polymerase, leading to drug resistance even HBV recurrence. Now adefovir dipivoxil is regarded as an effective remedy for YMDD variation. CONCLUSION:Virus variation and HBV recurrence can influence prognosis of HBV-related end-stage diseases after liver transplantation. Prevention and cure approaches are developing. It is important to find an economic, safe, convenient and effective therapeutic regimen. In addition, individualized treatment and the evaluation of risk and advantage should be emphasized.

Hepatic myelopathy is a rare disease with high mortality. There has been no report of an effective treatment to date. In order to evaluate the beneficial effect of orthotopic liver transplantation in patient with hepatic myelopathy. One patient, who was suffering from hepatie myelopathy complicating hepatic pathology, underwent liver transplantation in 2002 was studied. The muscle strength of the patient’s extremities was carefully assessed both pre-operatively and postoperatively. It was found that symptoms and signs of hepatic myelopathy were improved, especially the muscle strength recovered from 1-2 degree to 3-4 degree half a year after the operation. Therefore it is our belief that liver transplantation might be beneficial to patients who are suffering from hepatic myelopathy as a complication of the hepatic disease.

Objective To observe the therapeutic effects and side-effects of tacrolimus (FK506) in the recipients who had undergone liver transplantation, and summarize the clinical experience of its use. Method The clinical data of 36 recipients of allogeneic liver transplants followed by tacrolimus-based anticoagulant regimen were retrospectively analyzed. After liver transplantation, all the recipients received the triple-drug immunosuppressive protocol, including tacrolimus as the basic drug, mycophenolat-mofetil (MMF), and prednisone. Twenty-four of 36 cases received Zenapax as an antibody induction therapy. Results Acute rejection occurred in 3 of 36 cases. After the use of methylprednisolone and OKT3, acute rejection was reversed. The main side-effects of tacrolimus were nervous system disturbance(40.0%), hypertension(13.3%), hyperglycemia(26.7%), and liver dysfunction(6.7%). Conclusion Tacrolimus is a safe and potent immunosuppressive agent, which can decrease the incidence of rejection in liver transplant recipients. The dosage of tacrolimus should be adjusted according to trough level with in the therapeutic window. The timely and appropriate adjustment of the immunosuppressive strategy is essential for the recipient and graft survival. Meanwhile, it is emphasized that the regime should be individualized. [HS(1*2/3]

Objective To explore the effect of nitric oxide(NO) on pulmonary tumor necrosis factor?(TNF?) in murine acute necrotizing pancreatitis(ANP). Method Ninety-six SD rats were randomized into four groups:normal control group, ANP group, L-Arginine(L-Arg) pretreatment group and L-NAME pretreatment group (n=24 for each group). The protein content of bronchoalveolar lavage fluids(BALF), the myeloperoxidase(MPO) of lung tissue and TNF? produced by alveolar macrophages were evaluated. The expression of TNF? mRNA was measured. ResultMPO and protein of BALF reached a peak level at 12nd hr (10.78?0.58U/g for MPO and 2011?106?g/ml for protein content respectively).TNF? peaked on the sixth hour(1624?149)pg/ml. The expression of AM TNF?mRNA also peaked on the sixth hour (1.127?0.069) along with an increase of TNF? mRNA. A similar tendency was seen in L-Arg and L-NAME pretreatment groups, with changes being statistically different in the three groups when compared with that of normal control group(P

Objective:To investigate the protection mechanism of rosavin in learning and memory ability in subacute aged rats in-duced by D-galactose. Methods:Totally 48 SD rats were randomly divided into the normal group, model group, positive drug group, and rosavin group respectively at the dose of 6, 12 and 24 mg·g-1 . Except the normal group, the other rats were with neck subcuta-neous injection of D-galactose 120 mg · kg-1 · d-1 . After 4-week drug administration, the learning and memory ability of rats was studied using Morris water maze. PO2 , SaO2 , the activity of superoxide dismutase ( SOD) , catalase( CAT) and glutathione peroxidase ( GSH-Px) and the content of O2 and malonaldehyde( MDA) of rats in vivo were determined at the end of the experiment. Results:The aged rats treated with rosavin(12 or 24 mg·kg-1·d-1) were with significant shortened latent period in Morris water maze(P<0. 01 or P<0. 05), and with reduced total swimming distance and error angle. Meanwhile, rosavin(6,12 or 24 mg·kg-1·d-1) could im-prove the concentration of O2 ,PO2 and SaO2 , the activity of SOD, CAT and GSH-Px in brain, while decrease the content of MDA with certain dose-effect relationship. Conclusion:Rosavin can inhibit D-galactose induced learning and memory decrease in rats, and the effect may be related with the increase of oxygen content, enzyme activity protection of SOD, CAT, MAO and GSH-Px and decrease of MDA generation.

ObjectiveTo study the clinical features of stercoral bowel obstruction and perforation of colon in elderly patients MethodsThe data of 22 cases of stercoral bowel obstruction and 6 cases of stercoral perforation of colon in elderly patients in our hosital from January 1994 to December 2003 were analyzed retrospectively ResultsIn the 22 cases with stercoral bowel obstruction, 6 cases were recovered after operation, 6 cases suffered from stercoral perforation in which all cases were misdiagnosed before operation,and 2 cases were dead.ConclusionsThe prevalence of stercoral bowel obstruction and perforation of colon in elderly patients are increasing with population being aged. The cases without perforation are often recovered by non-operative therapy. The perforation case of stercoral bowel obstruction is relatively rare, easy to be misdiagnosed, and in high mortality. The Hartmanns ostomy should be the choice for the perforation.

Artery cannulation is one of the clinical skills that should be mastered by the internships of anesthesiology. In consideration of its invasiveness,teachers should carry out the clinical teaching strictly and patiently,and assist the internships to establish a correct opinion on clinical practice. We should train the internships step by step,improve their success rates on artery cannulation and avoid complications as far as possible.

Objective To survey the value of risperidone in the treatment of depression without psychotic symptoms. Methods 205 depressive patients were randomly divided into 3 groups: risperidone group, fluoxetine group and combined group (risperidone+fluoxetine). They were assessed with Hamilton Depression Scale (HAMD), Treatment Emergent Symptom Scale (TESS) before treatment and in 2nd week, 4th week, 6th week and 8th week after treatment. Results The reduction rate of HAMD of combined group was the best among three groups(P<0.05), and that of fluoxetine group was better than that of risperidone(P<0.01). The significant difference in reduction rate of HAMD between combined group and other two groups was observed since 2nd week after treatment(P<0.05). No difference in scores of TESS has been observed in any time among three groups. Conclusion Risperidone can improve the efficacy of fluoxetine on depression without psychotic symptoms without increasing side effects, but itself is less effective than fluoxetine.

Objective To explore the roles of B lymphocyte and plasma cell in liver allograft re-jection to find the evidences of humoral factor participating in the rejection. Methods Immunohisto-chemical inspection of C4d, CD20+ B lymphocytes and CD138+ plasma cells were performed in 34 liver biopsy specimens from 25 patients with hepatic injury and their preoperative specimens. Then we ob-served the variances of the above parameters in the liver biopsy specimens and the differences of them with different hepatic injuries. We further observed the relation of the presence of CD20+ B lympho-cytes and CD138+ plasma cells to C4d positivity. Meanwhile, we compared the difficulties of clinical therapy with different presences of CD20+ B lymphocytes and CD138+ plasma cells in the liver biopsy specimens. Results The positive ratios of CD20+B lymphocytes and CD138+ plasma cells were signif-icantly higher in the acute rejection group than in the non-rejection group(P<0. 05 and P<0. 01).The positive ratios of CD20+ B lymphocytes were markedly higher in the chronic rejection group than in the non-rejection group(P<0. 05). There was no difference in CD138+ plasma cells between the 2 groups. The degrees of hepatic injury could not influence the positive ratioes of CD138+ plasma, but the positive ratioes of CD20+ B lymphocytes in the heavy hepatic injury groups was higher than in the slight hepatic injury groups(P<0. 05). CD20+ B lymphocytes and CD138+ plasma cells presented fol-lowing C4d(P<0. 01 and P<0. 05). The effective power of steroid in the all-positive group was obvi-ously lower than in the all-negative group(P<0. 05). Conclusion Humoral immune may participate in some liver allograft rejection. It would be more favorable for observing and prewarning the humoral re-jection by finding CD20, CD138 and C4d by immunohistochemical staining in liver biopsy specimens with hepatic injury after liver transplantation. It would be helpful for choosing the therapeutic regi-mens of liver allograft rejection.

Objective Based on detection of the soluble LAIR-1 (sLAIR-1) and sIL-2R in the bile from recipient after liver transplant, the role of sLAIR-1 and sIL-2R in graft acute rejection were analyzed. Methods Bile sLAIR-1 level and sIL-2R were determined by double mAb sandwich enzyme linked immunosorbent assay in 55 cases of liver transplantation. Results In 22 recipients with normal graft function, sLAIR-1 and sIL-2R were detected at low level in the bile. In the 29 cases of liver acute rejection (AR), significant increase of bile sIL-2R level was detected on the lst and 2nd d before final diagnosis. With the effective methylprednisolone pulse therapy, sIL-2R level was decreased significantly on the 3rd d. On the other hand, remarkable increase of bile sLAIR-1 was found on the lst,2nd and 3rd d before final diagnosis. After of methylprednisolone pulse therapy for 3 d, bile sLAIR-1resturned to the control level. Conclusion Both bile sIL-2R and sLAIR-1 are detected at high level in the recipients suffering from liver acute rejection. The level of bile sLAIR-1 changes dramatically and responsively according to liver acute rejection. Therefore, detecting these two markers synergistically may be a promising monitor for rejection after liver transplantation.