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.

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 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.

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 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 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 .

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 evaluate the clinical and pathological characteristics and treatment of malignant phyllodes tumor of the prostate. Methods A 60 year old male patient with malignant phyllodes tumor of the prostate was reported.The complaints consisted of dysuria,intermittent gross hematuria for 1 year,and recurrent symptoms after TURP for 2 months.The enlarged prostate was 5 cm?6 cm and palpated softly and smoothly by DRE,and heterogeneous by CT.His serum PSA level was 1.25 ng/ml.Sarcoma of the prostate was suspected and radical prostatectomy was performed on him. Results The pathology showed a special type of epithelial stromal tumor like cystosarcoma phyllodes of the mammary gland. Microscopically, the tumor was composed of cystically dilated ducts with leaf like stroma projections in the lumen.The stroma cell proliferated obviously with atypia and high mitotic rate,and the epithelial cell also proliferated but with no atypia and no mitosis.The seminal vesicle and bladder neck had tumor infiltration and the diagnosis of malignant phyllodes tumor of the prostate was confirmed.The tumor margin was negative.With immunohistochemical staining,the stromal cells were positive for vimentin,but negative for actin,with the epithelial cells positive for CK,PSA and AE1/AE3,and the basal cells positive for CK34BE12.The patient had tumor recurrence after 6 months,but refused to further treatment and was followed up till now. Conclusions Malignant phyllodes tumor of the prostate is rare but can be diagnosed properly based on clinical and pathological features.Radical prostatectomy is considered to be the most reliable treatment.

Objective To investigate the incidence of renal dysfunction among patients received radical nephrectomy during 5-year follow-up and to discover the risk factors for chronic kidney dysfunction (CKD).Methods Data of 339 patients who underwent radical nephrectomy for renal cell carcinoma between Jan.2006 to Dec.2007 were investigated,and those who suffered renal dysfuntion before surgery or lost follow-up were excluded.Finally,148 patients were enrolled in this retrospective study.GFR after surgery were replaced by eGFR which were calculated with the abbreviated equation of MDRD.It will be defined as CKD when eGFR was less than 60 ml/(min · 1.73 m2).Postoperative occurence rate of CKD was estimated using the Kaplan-Meier methods.Rank sum test and chi-square test were used for the univariate analysis in term of CKD between groups.Multivariate Logistic regression analysis was used to judge the independent risk factors for CKD.Results Patients were followed up for 42-60 months.CKD occurred in 58 cases,and the 5 year cumulative incidence of CKD was 42.7％.As many as 17.4％ of the patients with a normal eGFR during the first 3 months follow-up would progress to CKD 5 years later.Clinical characteristics,including age at surgery,weight,body mass index,hypertension,preoperative total GFR and contralateral GFR,complications,size of tumor,pathologic type,eGFR calculated shortly after operation,were significantly different between the CKD group and the normal group (P＜0.05).Multivariate Logistic regression analysis shows that age at surgery (P =0.016,OR =1.106),size of tumor (P =0.048,OR =0.680) and eGFR calculated within one week postoperatively (P=0.002,OR=0.874) were the independent risk factors for postoperative CKD.Conclusions The incidence of CKD after radical nephrectomy in patients with renal cell carcinoma is not uncommon.The of age at surgery,size of tumor and eGFR value calculated within one week postroperatively have a close relation with the incidence of postoperative CKD.

Objective To investigate the related risk factors of bone cement leakage after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) of osteoporotic vertebral compression fracture.Methods A retrospective study was made on 108 patients (114 vertebrae) undergone PVP and PKP between January 2008 and June 2014.There were 32 patients with cement leakage and 76 patients without cement leakage.Between-group differences were analyzed in terms of gender,age,number of one-time treated vertebrae,anatomic dissection,surgical procedures (PKP or PVP),integrity of the posterior vertebral wall,puncture approaches (unilateral or bilateral),technical level of surgeons and bone cement volume.Results Bone cement leakage occurred in 36 vertebrae (with the proportion of 31.6％).Cement leakage was associated with number of one-time treated vertebrae,surgical procedures,fractured condition,and bone cement volume (P ＜ 0.05),but not with gender,age,anatomical site of injury,puncture approaches,and technical level of surgeons (P ＞ 0.05).Conclusions Bone cement leakage after PKP or PVP correlated with number of vertebrae with one-time therapy,surgical procedures,fractured condition,and volume of bone cement.A good master of technical procedures and indications and suitable injection of high viscosity bone cement can help reduce the incidence of cement leakage.