Anesthesia ; methods ; Child ; Child, Preschool ; Female ; Foreign Bodies ; surgery ; Humans ; Infant ; Male ; Muscle Relaxants, Central ; therapeutic use ; Respiratory System

Objective To explore the role of monitoring the cellular immune function in preventing and treating the fungal infection in the recipients of liver transplantation. Methods 679 cadaveric liver transplantations (from Jan. 2004 to Jan. 2010) were retrospectively studied. All the cases were divided into 3 groups according to different treatments and preventing regimens. The patients in groups A, B, C were treated based on the clinical experiences (394 cases), T lymphocyte subsets counting (151 cases), and combination of ATP values of CD4+ T cell and T lymphocyte subsets counting (134 cases), respectively. The infection, mortality and acute rejection rate were analyzed. The relationship between fungal infection and cellular immune function was investigated.Results The fungal infection rate in groups A, B, and C was 28. 9 %, 21.2 %, and 19. 4 % (P<0. 05), the morbidity rate was 16. 7 %, 12. 5%, and 3. 8% (P>0. 05), and the acute rejection rate was 28. 4 %, 17. 2 %, and 13. 4 % (P<0. 01), respectively. The CD4+ T lymphocyte counting in all cases of fungal infection was (147±43)×106/L. The morbidity could reach 50. 0 % when the CD4+ T lymphocyte counting < 100 ×106/L, while it was 2. 4 % when the counting was between (100-200) ×106/L (P<0. 01). The CD4+ T lymphocyte counting had no linear relation with the ATP value.The ATP value in fungal infection cases was (117 ± 61)μg/L. Conclusion The cellular immune function test could be quantitatively evaluated according to the T lymphocyte subsets and ATP value of CD4+ T lymphocyte. And individualized immunosuppressive therapy could be adjusted accordingly.Therefore, cellular immune function could be instructive in preventing and treating the fungal infection after liver transplantation.

Adult ; Child ; Endoscopy ; Fibrous Dysplasia of Bone ; pathology ; surgery ; Humans ; Male ; Nose ; surgery ; Orbit ; pathology

There is no a systemic performance metrics for clinical data management. While the CDMC in China starts to develop the quality metrics for clinical data management, it is essential to think over the performance and pursue metrics implementation of clinical data management in China. This article provides the basic concept, development and implementation of the performance metric in clinical data management.
China ; Clinical Trials as Topic ; standards ; Data Collection ; standards ; Information Storage and Retrieval ; standards

Objective To investigate the surgical options for the management of portal vein thrombosis (PVT) during liver transplantation and its impact on the outcome of patients. Methods 773 cases of liver transplantation were analyzed retrospectively. PVT occurred in 107 patients, inclu-ding 59 of grade Ⅰ ,33 of grade Ⅱ, 12 of grade Ⅲ and 3 of grade Ⅳ. Simple thrombectomy or thrombus-extraction was performed in grade Ⅰ and Ⅱ. 12 patients with grade Ⅲ received thrombus-extraction or using the donor iliac vein to act as a bridge between the donor portal vein and host superior mesenteric vein. Two cases of grade Ⅳ received a modified cavo-portal hemitransposition and one case received portal-vena coronaria varication anastomosis. Results Liver function had a good recover and the perio-perative mortality is 4. 3% in grade Ⅰ and Ⅱ. In grade Ⅲ , 5 cases received thrombus-extraction had a normal liver function after transplantation and had no died. 2 cases among the other 7 cases using por-tal vein reconstruction had bad liver function and died. The liver function recovered well after trans-plantation and there was no died in grade Ⅳ. Conclusions PVT is not a contraindication for liver transplantation. Good results can be obtained by applying reasonable operative procedures individually.

Objective To evaluate the therapeutic effects of liver transplantation (LT) for cholangiocarcinoma(CC)and analyze the prognostic factors.Methods From December 2001 to December 2006,234 patients receiving LT for hepatic carcinoma in our institute were enrolled as a basis of comparative study for 6 CC patients undergoing LT during the same period.Results These 6 patients were followed-up from 1 to 56 months.Five patients died and one recurred.The 0.5-,1-and 2-year patient cumulative survival rates were 4/6,3/6 and 1/6,respectively.The 0.5-,1-and 2-year tumor-free survival rates were 3/6,2/6 and 1/6,respectively.The average patient or tumor-free survival time were both(14±4) months.Conclusion The prognosis of cholangioearcinoma patients after LT iS poor.

OBJECTIVEExtracellular signal-regulated kinases (ERKs) can be activated by calcium signals. In this study, we investigated whether calcium-dependent kinases were involved in ERKs cascade activation after global cerebral ischemia.

METHODSCerebral ischemia was induced by four-vessel occlusion, and the calcium-dependent proteins were detected by immunoblot.

RESULTSLethal-simulated ischemia significantly resulted in ERKs activation in N-methyl-D-aspartate (NMDA) receptor-dependent manner, accompanying with differential upregulation of Src kinase and Ca2+/calmodulin-dependent protein kinase II (CaMKII) activities. With the inhibition of Src family tyrosine kinases or CaMKII by administration of PP2 or KN62, the phosphorylation of ERKs was impaired dramatically during post-ischemia recovery. However, ischemic challenge also repressed ERKs activity when Src kinase was excessively activated.

CONCLUSIONSrc family tyrosine kinases and CaMKII might be involved in the activation of ERKs mediated by NMDA receptor in response to acute ischemic stimuli in vivo, but the intense activation of Src kinase resulted from ischemia may play a reverse role in the ERKs cascade.

Analysis of Variance ; Animals ; Brain Ischemia ; enzymology ; pathology ; Calcium-Calmodulin-Dependent Protein Kinase Type 2 ; Calcium-Calmodulin-Dependent Protein Kinases ; metabolism ; Disease Models, Animal ; Extracellular Signal-Regulated MAP Kinases ; metabolism ; Gene Expression Regulation ; physiology ; Hippocampus ; cytology ; enzymology ; Male ; Neurons ; enzymology ; pathology ; Phosphorylation ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate ; metabolism ; Signal Transduction ; physiology ; Statistics, Nonparametric ; src-Family Kinases ; metabolism

OBJECTIVETo investigate the ways of inactivation and expression of p16 gene mRNA and its protein as well, and their clinicopathological significance in non-small cell lung carcinomas (NSCLC).

METHODSComparative- multiplex PCR, in situ hybridization, and immunohistochemistry were used to detect the promotor methylation status, mRNA, and protein expression in 64 cases of NSCLC, respectively.

RESULTSPromoter methylation of p16 gene was detected in 36 (56.3%) of 64 NSCLC cases. This positive result of methylation showed a negative correlation statistically with p16 protein expression by immunohistochemistry (P < 0.05). By in situ hybridization, 13 cases (20.3%) showed positive results for mRNA and all of these positive cases (13/13) had also a positive result by immunohistochemistry. Thirty-seven cases (57.8%) showed a negative immunohistochemical result. The metastatic rate of lymph nodes of those NSCLC patients with either promoter methylation or negative protein expression was higher (P = 0.038), and 3-year survival rate was lower statistically (P = 0.002).

CONCLUSIONDysfunction of p16 gene in NSCLC is mainly caused by promoter methylation, and patients with p16 gene dysfunction may have a poor prognosis.

Carcinoma, Non-Small-Cell Lung ; genetics ; pathology ; secondary ; Cyclin-Dependent Kinase Inhibitor p16 ; biosynthesis ; genetics ; DNA Methylation ; DNA, Neoplasm ; genetics ; Gene Expression Regulation, Neoplastic ; Gene Silencing ; Genes, p16 ; Humans ; Lung Neoplasms ; genetics ; pathology ; Lymphatic Metastasis ; Prognosis ; Promoter Regions, Genetic ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Survival Rate

Objective To evaluate low-weight mesh for tension-free repair of inguinal hernia in the elders. Methods 120 old patients ( age at 60 -97 years) underwent tension-free repair of inguinal hernia by using low-weight mesh. The early complications, time of up and about, hospital stay, postoperative chronic pain,foreign body feelings and hernia recurrence were analyzed. Results The operations were successful in all cases and the average time of operation was (43 ± 12 ) min. 9 cases suffered from edema of the scrotum, 5 cases suffered urine retention, 4 cases suffered from incision hematoma. The average time of outof-bed was ( 17.4 ± 1.8 ) h, the average hospital days was ( 7.4 ± 1.9) d. However, there were 1.7%(2/120) patients suffering from slight chronic pain and 9. 1% (11/120) patients complaining foreign body feelings. There was no recurrence after follow-up for 6 to 48 months. Conclusions The clinical application of low-weight mesh for tension-free repair of inguinal hernia in old age is safe and effective, with an additional advantage of low occurrence of chronic pain and foreign body feelings.

Objective To compare the development of gastric insufflation related to different peak inspiratory pressures (PIPs) during facemask ventilation in the pediatric patients.Methods Ninety male pediatric patients,aged 2-4 yr,of American Society of Anesthesiologists physical status Ⅰ,scheduled for elective surgery under general anesthesia,were randomly divided into 5 groups (n =18 each) using a random number table:PIP 8 cmH2O group (group P8),PIP 10 cmH2O group (group P10),PIP 12 cm H2O group (groupP12),PIP 14cmH2O group (group P14) and PIP 16 cmH2O group (group P16).Anesthesia was induced with fentanil,propofol and rocuronium in sequence.After loss of eyelash reflex,positive pressure facemask ventilation was performed for a 120 s period in pressure-controlled mode.Gastric insufflation was detected by real-time ultrasonography of the antrum,and cross-sectional antral area was measured using ultrasonography before facemask ventilation and at 120 s of facemask ventilation.The pulse oximetry (SpO2),tidal volume (VT),end-tidal pressure of carbon dioxide (PETCO2) and end-tidal oxygen concentration (ETO2) were recorded at 30,60,90,and 120 s of facemask ventilation.The development of gastric insufflation and hypoventilation was recorded.Results Compared with group P8,the incidence of gastric insufflation was significantly increased in group P16 (P＜0.01),and no significant change was found in the incidence of gastric insufflation in the other groups (P＞0.05),the incidence of hypoventilation was significantly decreased,VT and ETO2 were increased,and PET CO2 was decreased in P12,P14 and P16 groups,and PETCO2 was significantly decreased at 120 s of facemask ventilation (P＜ 0.05 or 0.01),and no significant change was found in the other parameters in group P10 (P＞0.05).Compared with P12 and P14 groups,VT was significantly increased,PEHTCO2 was decreased at 120 s of facemask ventilation (P＜0.05),and no significant change was found in the incidence of hypoventilation and ETO2 in group P16 (P＞0.05).There was no significant difference between group P12 and group P14 in the incidence of hypoventilation,VT,PETCO2 and ETO2 (P＞0.05).The pediatric patients showed a certain CO2 accumulation [PETCO2 (40.6±4.0) mmHg] at 120 s of facemask ventilation in group P8,and the pediatric patients showed excessive ventilation [PETCO2 (23.6± 1.4) mmHg],and cross-sectional antral area was not measured using ultrasonography in three cases because of excessive gastric insufflation in group P16.Conclusion PIP at 12-14 mmHg in pressure-controlled ventilation mode can not only ensure adequate preoxygenation and but also avoid excessive gastric insufflation during facemask ventilation in the pediatric patients.