Under active exploration and practice of several generations of organ transpant workers,organ transplantation in China has developed rapidly since 2000 and achieved remarkble results.Techniques of transplantation become mature,and liver transplantation and renal transplantation have reached international advanced level,which benefit massive patients.With high attention and promotion of national government and health administrative departments,structural changes have occurred to source of national organ transplantation to form a China Model.The donation after citizen's death has become the new normal in the organ transplantation in China.Human organ donation work promots the rapid development of transplantation in China,but it also faces challenges of the donor organ shortage and quality improvement.Under the new situation,health,family planning and medical reform work of the national13th Five Year Plan puts forward new requirements on human organ donation and transplantation.Combined with practical work,this article gives a few opinions on how to scientifically further improve the quality and quantity of organ donation and transplantation and directions of future works.

Objective To observe the recombinant human acidic fibroblast growth factor (rh-aFGF) treatment of open fractures of the tibia and fibula efficacy and safety.Methods Seventy-two cases of open fractures of tibia and fibula patients were selected,all patients were given the C-arm X-ray machine to guide needle,debridement,the entire complex fractures,external fixa tion device postoperative were given anti-infection treatment.Treatment group were given rh-aFGF 1-5 soluble solvent cleaning wounds and skin grafts,suture given daily dressing (3-4 spray/cm2,6-8 times/d).The control group was not given medication,continuous treatment after 7-14 d assess wound healing,wound complications and infection.Results Treated the wounds healing time,healing time,the incidence of delayed fracture healing,skin graft survival area,walking function recovery time,edema score,pain score,the incidence of severe infection and late healing in treatment group were significantly better than those in control group:(27.2 ± 13.1) d vs.(34.7 ± 12.3) d,(55.4 ± 17.4) d vs.(62.2 ± 18.7) d,(99.2 ± 1.2) ％ vs.(92.6 ± 3.6) ％,(2.2 ± 0.4) scores vs.(3.8 ± 0.4) scores,(2.1 ± 0.4) vs.(3.7 ± 0.2) socres,5.6％ (2/36) vs.30.6％ (11/36),2.8％ (1/36) vs.19.4％ (7/36),there were statistical differences (P ＜ 0.05).rh-aFGF treatment of major adverse reactions were mild itching.Conclusion The recombinant human acidic fibroblast growth factor can accelerate wound healing and reduce post-operative complications,reducing infection.

It is traditionally thought that interleukins are produced by immunocytes. However, abundant evidence indicates that neuron and neuroglia also produce and excrete interleukins. Brain derived interleukins have reciprocal action with multiple neurotransmitters, and influence animal's behavior, learning and memory. Moreover, brain derived interleukins are involved in Alzheimers disease, depression and so on. Further investigation on brain derived interleukins may improve in understanding the pathophysiology of some related diseases.

Objective:To evaluate construct validity of China residents health literacy questionnaire and explore the application of confirmative factor analysis(CFA)in health literacy measurements.Methods:CFA was performed on dimension of basic healthy skills in the questionnaire.Latent variable scores and comprehensive score based on factor variance weight were calculated.Comparison among the latent variable scores,comprehensive scores and proportion of knowing was conducted via GLM or Logistic model.Results:Two factors named general capacity and emergency capacity were well fitted(?2=12.12,P=0.356,IFI=0.998,TLI=0.996,RMSEA=0.007).According to comprehensive score the sample qualification rate of basic health literacy was 38.5%(785/2 040),much similar to 38.2%(780/2 040)which is calculated by original item scores.Latent variable score or comprehensive score has more statistical power than that of proportion of knowing in multivariate analysis.Conclusion:CFA is a useful tool and valuable for applying in the field of health literacy measurement and analysis.

Objective To investigate the prevalence of adult skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Liaoning Province and to observe the effects of preventive measures.Methods Three water-changed villages were selected from six drinking-water-borne endemic fluorosis counties,Faku County,Liaoyang County,Haicheng City,Linghai City,Fu Mongolia County,and Jianping County.Totally 18 diseased villages were selected as the investigation sites.The operating condition of the improvement projects was investigated and the fluoride level of drinking water was tested.People over the age of 25 and living in the local for more than 5 years in each survey site were selected and divided into five groups according to age groups of 25-,35-,45-,55-,and ≥65 years old.Ten people in each age group were selected,half male and half female,to examine skeletal fluorosis by X-ray.Clinical symptoms and bone change,including sclerotin,bones,and joints changes were also examined.Results The water fluorine values of two villages were 1.32 and 1.69 mg/L,more than the national standard (1.2 mg/L),while other 16 villages were between 0.5-1.0 mg/L.X-ray images were analyzed for diagnosis of skeletal fluorosis in 905 adults,and 46 cases were diagnosed as skeletal fluorosis in the 18 monitored villages.Xray detection rate was 5.08％,of which the X-ray detection rate of adult fluorosis in water fluoride qualified monitoring villages was 4.11％ (33/803).The detection rate of adult skeletal fluorosis was 12.75％ (13/102) in water fluoride unqualified monitoring villages.There was a significant difference of the total detection rates between the two groups of monitored villages (x2 =13.99,P ＜ 0.05).Skeletal fluorosis was mainly happened in the age group over the age of 45,account for 89.13％ (41/46).Peri-bone changes were observed in the 46 cases of patients with skeletal fluorosis.Conclusions The condition of skeletal fluorosis has been effectively alleviated after implementing the improvement measures.Prevention and treatment can effectively control the occurrence of fluorosis.

Objective To investigate the influence of the fish oil fatty acid (rich in ω-3 polyunsaturated fatty acids ) acting on the cellular immune and inflammatory response of perioperative patients of gastrointestinal tumors .Methods 79 gastrointestinal tumors patients who took total parenteral nutrition (TPN)after operation are divided into 2 groups randomly(collected from July 2010 to June 2012) .39 patients in study group are supplied with fish oil fatty acid within 24 h after operation and 7 d in total .40 pa-tients in the control group are supplied with ordinary long chain fat emulsion within 24 h after operation ,7 d as a course .The per-centage and the ratio of T lymphocyte subsets(CD3 ,CD4 ,CD8) ,monocyte human leukocyte antigen DR(HLA-DR) expression(per-centage) and the number of monocytes of 2 groups were test by blood test at 1st and 8th day after operation .Results The ratio of CD3、CD4、CD8、CD4/CD8 ,monocyte(HLA-DR) expression(percentage) and the number of monocytes in the study group were sig-nificantly higher than that of control group after received fish oil fat emulsion (P<0 .05) .There was no significant difference be-tween two groups on the 1st day after operation of C reactive protein (CRP) ,interleukin-1β(IL-1β) ,IL-6) ,IL-2 and IL-12(P>0 .05) .However ,compared with their results shown that they all had obvious difference respectively by a eight-day observation(P<0 .05) .compared with the first day the CRP in the control group at 8th day after operation were significantly higher than that of the 1st day ,the study group at 8th day was obviously decreased ,the difference was statistically significant (P<0 .05);IL-1βand IL-6 of the two groups were decreased at 8th day after operation and the study group decreased more obviously than the control group (P<0 .05) .IL-2 and IL-12 of the 2 groups at 8th day after operation were decreased than that of the 1st day ,but the difference between the two groups was not statistically significant (P>0 .05) .Conclusion Given the fat emulsion of fish oil which is rich in ω-3 poly-unsaturated fatty acid can significantly improve the cellular immune function of postoperative patients and release the inflammatory response after operation in patients of gastrointestinal tumors .

Objective To investigate the characters of morphology change and protein expres-sion in progressed renal cell carcinoma after the treatment of sorafinib. Methods Clinical data of 2 cases with progressed renal cell carcinoma treated with sorafenib were collected. The HE slices were reviewed. Immunochemistry was used to detect the expression of Vimentin, AE1/AE3, CK7, CK8, CK18, CD10, VEGF, VEGFR2, p53 and Ki-67 levels. Results There was no difference in patho-logic type between before and after the therapy of sorafenib. Both of the 2 cases were showed degener-ation in tumor cell in different degree with fibrosis and necrosis. The expression of renal cell carcinoma related antigens (Vimentin, AE1/AE3, CK7, CK8, CK18 and CD10) had no difference before and af-ter the treatment of sorafinib. The expressions of VEGF, VEGFR2, p53 and Ki-67 were increased, and the expression of Bcl-2 was decreased after the therapy of sorafinib. Conclusions There may be some morphologie differences between the metastatic tumor or the recurrent tumor and primary tumor because of the treatment of sorafenib. However the pathologic type is the same before and after the treatment of sorafenib. The main differences are the degeneration of the tumor cell and fibrosis after the treatment of sorafenib. The expression changes of VEGF and VEGFR2 may be related to the sor-afenib application.

This article described systematically the design basis,passing standard and influential factor of test score of the assessment scale of simulated clinical skills examination.Through developing and modifying OSCE examination scale design for many years,we have found that the use of 360-degree assessment for designing OSCE assessment rating scale can effectively reduce the impact on the score of examinee owing to the environment,the candidates,raters and question design,which has an important role for scientific development of OSCE assessment scales,as well as improving the reliability and validity for development of a scientific OSCE assessment.

Objective To explore differences of ultrasoundgraphy and CT guided percutaneous paracentesis for liver abscess and provide references for the paracentesis treating of liver abscess .Methods 68 patients with liver abscess arranged ultrasoundgraphy guided percutaneous paracentesis were regarded as ultrasound group ,and 38 patients accepted CT guided percutaneous paracentesis were considered as CT group .The succeed rate of paracentesis ,operation period ,treatment effectiveness ,complications of the 2 groups were compared .Results The succeed rate of paracentesis in ultrasound group (81 .7% ) was not different obviously to CT group(82 .6% ) (χ2 =0 .016 2 ,P=0 .898 6) .The operation period of ultrasound group(22 .3 ± 5 .6)min was shorten than CT group (25 .6 ± 4 .8)min ,t= 3 .057 4 ,P< 0 .05 .The heal rate of the 2 groups(91 .2% ,92 .1% ) was not different (χ2 = 0 .027 1 ,P=0 .869 3) .There was no different of the complications in the 2 groups(5 .88% ,8 .57% )(χ2 =0 .010 1 ,P=0 .920 1) .Conclusion Either ultrasoundgraphy or CT guided percutaneous paracentes is feasible and safe for liver abscess .Compared to CT ,the ultra-soundgraphy is more convenient and economic .

Objective To investigate the risk factors of chylous leakage after pancreatioduodenectomy so as to find effective measures to prevent this complication.Methods A retrospective analysis was conducted on 230 patients who underwent pancreatioduodenectomy at the First Affiliated Hospital of Zhejiang University from Jun.2012 to Jun.2014.Patients with chylous leakage were identified and a 1 ∶ 2 patients in the study and the control groups were selected.The parameters for matching included tumor volume,vascular invasion,and extent of lymph node dissection.A logistic analysis was performed to identify independent risk factors of chylous leakage.Results 15 (6.5％) patients developed chylous leakage after pancreatioduodenectomy.The average hospital stay after surgery of the study group was 20.8 days,compared to 13.5 days in the control-group (P =0.004).In the study group,chylous leakage rate increased in patients with 14th and 16th group of lymph nodes dissection (80％ vs 36.7％,P =0.006).Logistic analysis showed that 14th and 16th lymph nodes dissection was an independent risk factor of chylous leakage after pancreatioduodenectomy (P ＜ 0.05,OR =6.909,95％ CI 1.593 ～ 29.958).Conclusions Chylous leakage prolonged hospitalization after pancreatioduodenectomy.Dissection of the 14th and 16th lymph node groups was an independent risk factor of chylous leakage after pancreatioduodenectomy.Careful ligation of the gastrocolic vein near the lymphatic trunk and dissection of 14th and 16th group of lymph nodes were effective interventions to reduce postoperative chylous leakage.