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.

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.

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

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.

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.

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 distinction between measles vaccine strain Shanghai-191 (S- 191) and wild-type strains in China at molecular level. Methods After having been amplified by RT-PCR, the nucleotides of S-191 was sequenced and analyzed with reference to the sequences obtained from Gen- Bank, which includes 24 whole genome sequences, 211 sequences of wild-type strains isolated from China and WHO reference strains. Results The sequence of S-191 strain had been submitted to GenBank. Phylo- genetic analysis of the COOH terminal 456 nucleotides coding for the nucleoprotein (N) indicated that most of the measles virus strains from China were members of clade H1. The genetic distances between the virus strains detected in a number of provinces and S-191 strain were 6.7% -8.2%. It is noteworthy that the muta- tion rate of non-coding regions was considerably higher than that of coding regions. The mutation rate of N gene was the highest among all of the coding regions. Conclusion This report shows that genotype H1 is widely distributed throughout the country. The circulation has no apparent geographic and temporal restric- tion. The evolution of measles virus should be closely followed.

BACKGROUND: Hepatic myelopathy results from liver disease, which lacks of effective cure method. Liver transplantation has attempted to cure this disease; however, the long-term therapeutic effect is rarely reported. OBJECTIVE: To explore the long-term therapeutic effect of liver transplantation in patients with hepatic myelopathy. METHODS: The clinical data of 2 patients with hepatic myelopathy, who underwent orthotopic liver transplantation, in August 2002 and November 2004, at the 309 Hospital of Chinese PLA, were analyzed retrospectively. The time of follow-up was 18 and 43 months, respectively. The muscle strength of double lower limbs in 2 patients was assessed prior to and after operation. RESULTS AND CONCLUSION: Two patients recovered well at 4 weeks after transplantation, the clinical symptom and physical signs of patients were improved obviously, the blood routine examination and other biochemical index were normal,and the function of transplanted kidney was normal. Two patients discharged at 6 weeks after transplantation. Patient 1 could stand for a long time at months 6 after transplantation, walked slowly with the supporter after 12 months and without the supporter at 43 months. The muscular strength of two lower limbs was grade 4. And the liver function was normal. Patients 2 could move his lower limbs in bed at months 6 after transplantation, walked with the supporter at 18 months. The muscular strength of two lower limbs was grade 3. The liver function was normal. It demonstrated that liver transplantation is beneficial to control hepatic myelopathy and recover muscular strength of two lower limbs. It is a newly developed, effective curing method for treating hepatic myelopathy. However, the numbers were small with short time observation, thus, the long-term therapeutic effect still need to be explored.