Acute rejection is one of the serious early postoperative complications after liver transplantation.Many studies have shown that acute rejection was mainly mediated by T cells,while humoral factors were responsible for chronic rejection.However,accumulating evidences have demonstrated that humoral immune factors also played an important role in early acute rejection and usually resulted in severe adverse events.Here we clarify the role of humoral immunity in liver transplant rejection,which may help guide the clinical management of such patients with humoral rejection after liver transplantation.

Objective To evaluate the effects of curcumin pretreatment on the expression of Nrf2 protein during ventilator-induced lung injury in rabbits.Methods Twenty-four healthy male New Zealand white rabbits,aged 3-6 months,weighing 2.5-3.0 kg,were randomized into 3 groups (n =8 each) using a random number table:two-lung ventilation (TLV) group; one-lung ventilation (OLV) group; and curcumin pretreatment group (group Cur).In group Cur,curcumin 40 mg/kg (dissolved in 2 ml of 1％ sodium carboxymethylcellulose) was given via a gastric tube into the stomach twice a day for 7 consecutive days starting from 7 days before ventilation,while the equal volume of sodium carboxymethylcellulose was given via a gastric tube instead of curcumin in TLV and OLV groups.All the rabbits were tracheostomized,and a tracheal tube was inserted to perform TLV in TLV group,and a tracheal tube was inserted into the right bronchus to establish OLV in OLV and Cur groups.Volumecontrolled ventilation was used in the three groups and the ventilatory parameters were regulated to maintain SpO2 ＞ 90 ％.Immediately before beginning of ventilation (T0) and at 1,2 and 3 h of ventilation (T1-3),arterial blood samples were obtained for blood gas analysis and determination of PaO2.The oxygenation index was calculated.At the end of ventilation,the rabbits were sacrificed and right lungs were removed for determination of wet/dry lung weight ratio (W/D ratio).The right lower lobe was isolated and puhmonary specimens were obtained for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity (using colorimetric method) and the expression of Nrf2 and HO-1 protein (by Western blot) in lung tissues and for microscopic examination of pathological changes of the lung which were scored.Results Compared with group TLV,the W/D ratio,pathological scores,MDA content,and expression of Nrf2 and HO-1 were significantly increased,and the SOD activity and oxygenation index at T2,3 were decreased in OLV and Cur groups (P ＜ 0.05).Compared with group OLV,the W/D ratio,pathological scores,and MDA content were significantly decreased,and the SOD activity,oxygenation index at T3,and expression of Nrf2 and HO-1 were increased in group Cur (P ＜ 0.05).Conclusion Curcumin pretreatment reduces ventilator-induced lung injury through promoting the expression of Nrf2 protein in lung tissues in rabbits.

Objective To investigate the mechanism of regulating gastrointestinal motility by elec- troacupunturing point of"Zusanli"in rabbits.Methods Thirty adult rabbits were divided into control, electrical acupuncture point of"Zusanli"and non acupuncture point groups.The blood concentrations of motilin were detected at different times(before acupuncture and 15,30,45 and 60 min after acupunc- ture).Sixty min after acupuncture,the mice were sacrificed.The acetylcholine esterase and nitric oxide synthase(NOS)in gastric and jejunum tissues were examined.The electron microscope was used to observe the vesicles of nerve ending.Results The concentrations of motilin in electrical acupuncture group was significantly increased and reached the high peak at 45min.The activities of acetylcholine es- terase was increased significantly in electrical acupuncture group compared to control group[gastric tis- sue:(15 571?2876)pinel vs(9081?801)pinel,P

Objective To remind the attention to contraceptive in cesarean section group by analyzing the treatment of 104 cases cesarean scar pregnancy (CSP).Methods From April 2009 to November 2012,104 patients with CSP treated in Department of Obstetrics and Gynecology,Wuhan Union Hospital were studied retrospectively.The incidence,treatment,and average in hospital days and average cost of hospitalization were analyzed.Results From 2009 to 2012,the number of CSP was 10,19,29,and 46 cases annually which accounted for the proportion of the corresponding period of gynecological patients were 0.33％,0.63％,0.97％,and 1.53％.Bilateral uterine artery embolization plus curettage was the most effective treatment.The average transfusion rate was 25％.The average amount of in-hospital days were (14 ± 8) days,the average cost of hospitalization were (12954.97 ± 3888.89) yuan.Conclusions The CSP incidence was increasing sharply in China.Although the current treatment methods could greatly reduce complications of CSP,it did harm to the patients and their family.The key to reduce the occurrence of CSP included reducing the rate of cesarean section,and strengthening contraceptive education after cesarean section.

Prominent problems of clinical teaching in Tibet University school of medicine were analyzed and countermeasures were proposed from aspects of management system construction, facul-ty construction, curriculum construction, base construction and quality evaluation system construction. The aim was to increase students' opportunity, enhance students' learning interest and improve stu-dents' ability of analysis and problem solving so as to improve the practical effects of clinical teaching. All countermeasures taken above laid the foundation for future clinical work and provided help for clinical medical personnel in Tibetan border areas.

Objective To systematically review the clinical efficacy of transanastomotic pancreatic ductal stents placement after pancreaticoduodenectomy.Methods According to the Cochrane reviewers handbook (version 5.0 ),literatures were retrived from PubMed,Embase,Cochrane,VIP database,China Biology Medicine disc and CNKI database,and then the quality of the literatures was analyzed.Meta analysis was carried out using the RevMan software ( version 5.0.18 ).A random effects model was adopted,and the results of the meta analysis were presented with odds ratio (OR) and 95％ confidence interval (95％ CI).Results Four randomized controlled trials including 557 patients were retrieved.External stents were used in 160 patients and internal stents in 115 patients.The results of meta analysis showed no significant difference in the rate of fistula,overall postoperative morbidity and mortality between patients who did or did not receive pancreatic stents placement (OR =0.66,0.70,0.63,P ＞ 0.05 ).There were significant differences in the rate of pancreatic fistula and overall postoperative morbidity between patients who received external pancreatic stents placement and those did not receive pancreatic stents placement ( OR =0.48,0.55,P ＜ 0.05 ).There was no significant difference in the mortality rate between patients who received external pancreatic stents placement and those did not receive pancreatic stents placement (OR =0.71,P ＞ 0.05 ).There were no significant difference in the incidence of pancreatic fistula,overall postoperative morbility and mortality between patients who received internal pancreatic stents placement and those did not receive pancreatic stents placement ( x2 =0,0.75,2.11,P ＞ 0.05 ).Conclusions External pancreatic stents placement after pancreaticoduodenectomy can reduce the incidence of postoperative complications.The effects of internal pancreatic stents placement need to be proved by further highquality prospective randomized trials.

Objective To explore the situation of respiratory virus co-infection with EV71 and CA16 in patients with hand,foot and mouse disease(HFMD) ,and analyze the influence of co-infection on clinical aspects.Methods From June to October of 2010,there were 348 patients enrolled in the study,with 248 hospitalization cases and 100 mild outpatients.All the patients were diagnosed as HFMD in Beijing You-an Hospital.The viral RNA from the pharynx swab samples were extracted and reversely transcribed by RT-PCR.All the samples were detected with the EV71 and CA16 by real-time fluorescence quantitative PCR.Twelve kinds of respiratory viruses were detected by a commercial multiplex-PCR method.The PCR products were confirmed by electrophoresis.Chi square test was used in the data analysis.Results Of the 348 HFMD patients,36 subjects were detected as positive for respiratory virus co-infection.In the 248 hospitalization cases,111 cases were positive for EV71 or CA16,with eight cases identified with respiratory virus co-infection(7.2%); the other 137 cases were negative for EV71 and CA16,with eleven cases identified with respiratory virus co-infection(7.4%).There was not significant difference between respiratory virus co-infection and the identification of EV71 /CA16(x2 = 0.059,P ＞ 0.05).In the 100 mild outpatients positive for EV71 or CA16,seventeen cases were identified with respiratory virus co-infection(17%).The rate of respiratory virus co-infection in the mild outpatients was much higher than in the severe hospitalization patients(x2 = 4.830,P＜ 0.05).Among the 111 EV71(+) or CA16(+) inpatients,there were 101 cases diagnosed as severe cases(91.0%); similarly,there were 132 cases diagnosed as severe cases(96.4%) among the 137 EV71(-) CA16(-) cases.There was not difference between the identification of EV71/ CA 16 and illness of HFMD(x2 = 3.099,P ＞ 0.05).The leading respiratory virus being identified were HRV A/B,PIV3 and FLU A in the 348 HFMD patients.Conclusions Co-infection with respiratory virus exists in the HFMD patients. However,the respiratory virus infection has no significant influence to the state of HFMD illness.

ObjectiveTo evaluate the clinical outcomes of anterior lumbar discectomy and interbody fusion with cage under laparoscopic assistant.MethodsFrom January 2006 to June 2009,37 cases with degenerative low back pain were entered the study,including 22 males and 15 females with an average age of 43.7 years(range,16-55).The responsible discs were determined according to the three dimensional computed tomography of artery and vein angiography of anterior lumbosacral spine and discography,including L5S1 in 21 cases,L4-5 in 11,L3-4 in 2,L2-3 in 2,and L1-2 in 1.All cases underwent anterior lumbar discectomy and interbody fusion with cage under laparoscopic.ResultsThe operation time was 100 min in average (range,60-140),the blood loss was 120 ml in average(range,50-300).There was no case with severe complications of retrograde ejaculation and injury of great vessels or nerves.Delayed intestinal obstruction was discovered in two intraperitoneal route patients.The average follow-up time was 18.7 months(range,6-35).According to the back pain grading criteria of Chinese Medical Association Orthopedics Society of Spine Group,the results were excellent in 23 patients,good in 11,and fair in 3.The interbody fusion was obtained in 3 months later in 23 cases and 6 months later in 12 cases.Cage subsidence occurred in 2 cases in 6months after operation,in which the height loss of intervertebral space was 1.3 mm and 1.9 mm,but no obvious symptoms of discomfort.No fixation displacement or loosening occurred.ConclusionThe anterior discectomy and interbody fusion by internal fixation with laparoscopic technique is feasible with low complications rate,less trauma and shorter bedtime.Postoperative ileus by abdominal approach is relatively common.The surgeons experience and the anatomy of artery and vein of anterior lumbosacral spine should be considered before the choice of surgical approach.

Objective To evaluate the effects of sevoflurane-remifentanil anesthesia on the balance between cerebral oxygen supply and demand during cerebral revascularization for ischemic moyamoya disease by monitoring regional cerebral O2 saturation (rSO2) with near infrared spectroscopy.Methods Forty patients of both sexes aged 19-59 yr with a body mass index of 19-25 kg/m2 undergoing superficial temporal artery-middle cerebral artery anastomosis were randomly allocated into 2 groups (n =20 each):propofol-remifentanil group (group PR) and sevoflurane-remifentanil group (group SR).Radial artery was cannulated for direct BP monitoring and blood sampling.Near infrared spectroscopy probe was placed on the forehead.Anesthesia was induced with propofol TCI (Cp =5 μg/ml),fentanyl 3 μg/kg and rocuronium 0.6 mg/kg.The patients were mechanically ventilated after tracheal intubation (VT 8-10 ml/kg,RR 10-12 bpm,I∶ E 1∶2,FiO2 =1.0).PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with sevoflurane (end-tidal concentration 1.0％-1.7 ％) or propofol TCI (Cp =3-4 μg/ml) in combination with remifentanil TCI (Cp =3.5 ng/ml) and intermittent iv boluses of rocuronium 0.3 mg/kg.BIS was maintained at 40-60 during operation.rSO2 was recorded before induction of anesthesia (T0),10 min before and 10 min after blood vessel was clamped (T1,T2) and 10 min after anastomosis was completed (T3).Results rSO2 was significantly increased on the operated side at T3 in PR group while in SR group bilateral rSO2 was significantly increased at T1-3 as compared with the baseline values at T0 (P ＜ 0.05 or 0.01).rSO2 on the operated side was significantly higher at T1 in group SR than in PR group (P ＜ 0.05).Conclusion The efficacy of sevoflurane-remifentanil anesthesia is similar to that of propofol-remifentanil anesthesia for revascularization for moyamoya disease in terms of maintence of the balance between cerebral oxygen supply and demand.