(0.05). The CsA dosage and C 2 concentrations were lower in group II than in group I.Conclusion Neoral C 2 monitoring are beneficial to clinical outcomes in elderly Chinese renal transplant recipients and C 2 (concentration) is lower in elderly recipients than in young ones.

Objective To summarize the diagnosis and therapeutic experience of insulinoma in order to improve the surgical success rate and prognosis. Methods The clinical data of 138 patients with insulinoma from 1966 to 2007 were retrospectively analyzed. Results In this group of patients, hypoglycemia of different levels and Whipple triad were detected. 64 patients expressed different psychic symptom, 12 patients' psychic symptom were still present after blood glucose normalized after operation. Fasting serum insulin values in 88 patients were measured, and the insulin release index was higher than 0. 3. Before operation, tumor was detected in 8 of 75 patients by B-ultrasound scan, and in 17 of 68 patients by CT, and in 5 of 10 patients by MRI. The intra-operative B-ultrasound (IOUS) examination was applied in 44 cases, and 43 cases were successfully detected. The operations included enucleation of insulinoma (n=88) , resection of the body and tail of pancreass (n = 44) , pancreaticoduodenectomy (n=2) , and biopsy (n=1). The blood glucose symptoms normalized postoperatively in 132 patients. The blood glucose rebound in 110 patients, but blood glucose normalized within 2 weeks. After operation, 20 patients developed pancreatic fistula, 32 patients developed acute pancreatitis. Conclusions Insulinoma could be qualitatively diagnosed according to Whipple triad and the insulin release index. Operations with IOUS were simple and effective methods to localize the tumors. The only way to cure insulinoma was operation, and IOUS guided operation could avoid main pancreatic duct and vessel injury, decrease post-operative complications.

Objective To investigate the influence of cognitive behavioral intervention on self efficacy and quality of life in patients with chronic hepatitis B (CHB).Methods 90 patients with chronic hepatitis B were randomly divided into cognitive behavioral intervention group and control group,45 cases in each group.The patients of the control group were treated with routine treatment,the intervention group was given cognitive behavior intervention on the basis of conventional treatment.The general self efficacy scale (GSEs) and SF-36 quantity form (SF-36) were used to evaluate the effects of intervention.Results Before the intervention,the GSES score and SF-36 scores of each dimension of the two groups had no statistically significant differences (all P ＞ 0.05).After intervention,the GSES scores of the intervention group was (22.53 ± 4.12) points,which was significantly higher than (17.82 ± 4.51)points of the control group,there was significant difference between the two groups (t =4.918,P ＜0.01).The dimensions of the intervention group SF-36 score[comprehensive health status (16.13 ± 2.04)points and physical function (17.73 ± 3.49) points,mental health (15.73 ± 2.69) points,role limitations (18.38 ± 2.78) points,social function (14.76 ± 2.96) points,physiological (15.89 ± 2.85) points,vitality and energy (19.18 ± 3.43) points,body pain (19.84 ± 3.78) points] were significantly increased,and compared with the control group [general health status (12.62 ± 2.15) points and physical function (13.18 ± 2.31) points,mental health (9.24 ± 3.54) points,role limitations (8.67 ± 3.47) points,social function (9.24 ± 2.42) points,physiological (8.67 ± 2.60) points,vitality and energy (10.64 ± 2.73) points,body pain (10.80 ± 2.40) points],the differences were statistically significant (t=6.896,8.863,9.189,17.309,9.287,12.046,11.645,14.937,all P＜0.05).Conclusion Cognitive behavioral intervention can significantly enhance the self-efficacy of patients with hepatitis B,and improve the quality of life of patients,it can be popularized in clinical work.

Objective To investigate the clinical features , diagnosis and key technique points of laparoscopic partial adrenalectomy for small adrenal pheochromocytoma . Methods From Oct.2006 to Jun. 2011, clinical data of 32 cases with small adrenal pheochromocytoma (≤3.0 cm) were collected and retro-spectively analyzed .Hypertension was observed in 12 patients, whereas 20 patients presented with adrenal incidentaloma .Thirteen patients had a left adrenal neoplasm , eighteen patients had a right adrenal tumor , while one patients had bilateral tumors .The positive rate of plasma-free metanephrines ( MNs) and 24-hours urinary catecholamine (CA) in diagnosing small renal pheochromocytomas was 92.6%(25/27) and 81.3%(26/32) respectively.The main localization diagnosis included ultrasonography , 131I-MIBG, and CT or MRI, with positive rates of 71.9%(23/32), 93.8%(15/16) and 96.9%(31/32) respectively.All the laparoscopic adrenalectomies were performed retroperitoneally .During the surgery , the internal part of the adrenal gland closing to the retroperitoneum was dissected first , and the whole adrenal gland was resected completely. Results Partial adrenalectomy was performed for 30 cases and radical adrenalectomy for 2 ca-ses.All operations were successful without perioperative or postoperative complications .The maximum diame-ter of tumor was 1.7±0.2 (1.0-3.0) cm.Histopathological results showed that all the cases were benign pheochromocytoma.The operative time was 82 (40-210) min.The estimated blood loss was 57 (20-180) ml.No patient required blood transfusion . Conclusions Plasma-free MNs, 24-hours urinary CA and VMA are important qualitative examinations in detection of adrenal pheochromocytoma .Ultrasonography , CT,MRI, and 131 I-MIBG are important in the localization of adrenal tumors .Retroperitoneal laparascopic partial adrenalectomy is the preferred choice in the management of small adrenal pheochromocytoma .Dissecting the internal part of the adrenal gland closing to the retroperitoneum first and exploring the whole adrenal tissue are the key technique points during the operations .

Objective To summarize the experience in the diagnosis and management of insulinoma. Methods From January 1966 to December 2007, the clinical data of 131 patients with insulinoma were retrospectively analyzed. Results All the 131 cases had Whipple triad syndrome and 64 eases suffered from psychoneurosis symptoms. The fasting blood glucose or insultus blood glucose concentration of all the cases was lower than 2.8 mmol/L. The ratios of serum insulin to glucose were all higher than 0.3. Before operation, tumor was detected in 8 of 75 patients by B-us scan, and in 17 of 68 by CT, and in 5 of 10 by MRI. The intraoperative ultrasonography(IOUS) was applied in 44 eases, and tumor was found in 43 cases. Surgery included enucleation of insulinoma (88 cases), resection of the corpus and eauda of the pancreas (40 cases), duodenopancreatectomy (2 cases), and biopsy (1 case). The low blood glucose symptoms disappeared postoperatively in 130 cases. Pancreatic fistulae occurred in 20 cases, acute pancreatitis occurred in 32 cases. Conclusions Insulinoma can be diagnosed based on symptoms of Whipple triad and the ratio of serum insulin to glucose. Exploration and IOUS are the simple and effective methods to localize insulinoma.

Objective To investigate the relationship between the polymorphism of human multidrug resistance 1 gene(MDR1)polymorphism and early MMF pharmacokinetics.Methods Twenty-eight Chinese primary renal transplant recipients were emrolled.On day 14 post-transplant,patients took the MMF orally on fast.Whole blood samples(2 ml)were obtained at the following time points:predose(G0)and 0.5,1,1.5,2,4,6,8,10 and 12 h(C0.5,C1,C1.5,G2,C4,C6,C8,C10,C12,respectively)postdose during the dosing interval.The MPA plasrna concentration was assayed by high performance liquid chromatography (HPLC).Pharmacokinetie parameters were determined by WINNOLIN 3.1.Three major single nucleotide polymorphisrrls(SNP),C1236 T,G2677 T/A,C3435 T of MDR1 were analyzed by PCR-RFLP.Pharmacokinetie parameters of MPA were compared between different MDR1 genotype and haplotype groups.Ailele frenqueneis were also compared in high(MPA area under concentratation-time curve 0～12 h,frequencies of 1236 TT,2677 TT/AA,3435 TT in three major MDR1 SNP positions,exons 12,21 and 26,were 0.368,0.184 and 0.211,respectively.MPA AUC was significantly higher in 1236 TT group than in 1236 CC/CT group(65.36±11.51 vs 53.33±13.77,P=0.032).On C1236 T SNP,TT genotype frequency showed significant difference between MPA high and low exposure groups(66.7%vs 15.4%,P=0.013,OR=2.526).T allele frequency was marginally higher in MPA high exposure group than that in low exposure group(83.3%vs 53.3%,P=0.072).Conclusion TT genotype on 1236 of MDR1 indicates a risk of early high exposure to MPA in Chinese renal transplant patients given by oral MMF,

Objective To analyze the antithrombotic effects of cilostazol combined with aspirin and clopi-dogrel in elderly patients with cerebrovascular disease after PCI .Methods 100 elderly patients with cerebrovascular diseases who treated with coronary artery interventional therapy ( PCI) were randomly divided into the control group and the observation group according to the digital table ,50casess in each group.The two groups were given control of blood pressure ,blood lipids ,blood sugar ,improve circulation and other conventional treatment .The control group was treated with aspirin combined with clopidogrel ,the observation group was treated with cilostazol based on the treatment of control group.Before and after treatment for 1,4 and 8 weeks,the platelet aggregation degree was detected by PL-11 automatic platelet analyzer .During 2 months of follow-up,the degree of platelet aggregation ,the volume of platelets,the efficacy of treatment and the incidence of adverse reactions were compared .Results The platelet aggre-gation rate between the two groups had no statistically significant difference before treatment (t0 =2.782,P>0.05). After treatment,the platelet aggregation rate of the two groups decreased significantly ,but after treatment for 1,4 and 8 weeks,the platelet aggregation rates of the observation group were significantly lower than those of the control group [(51.87 ±9.65)％,(40.85 ±10.24)％,(38.52 ±9.64)％;(69.25 ±8.41)％,(62.43 ±9.22)％,(58.46 ± 10.18)％],the differences were statistically significant (t1 =5.693,t4 =4.846,t8 =6.719,all P<0.05).Before treatment,the mean platelet volume between the two groups had statistically significant difference ( t0 =2.146,P>0.05).After treatment,the platelet volume of the two groups decreased significantly ( t1 =1.656,t4 =1.438,t8 =2.189,all P<0.05).There were no statistically significant differences between the observation group and the control group (t1 =3.716,t4 =1.271,t8 =2.523,all P>0.05).The effective rate of the observation group was 94.00％(47/50),which was significantly higher than that of the control group [82.00％(41/50)],the difference was statis-tically significant (χ2 =4.683,P<0.05).The incidence rates of adverse reactions in the observation group and the control group were 10.00％(5/50) and 8.00％(4/50),respectively,there was no statistically significant difference between the two groups (χ2 =1.947,P=0.136).Conclusion Cilostazol combined with clopidogrel and aspirin in the treatment of elderly patients with cerebrovascular disease after PCI can significantly reduce platelet aggregation rate,improve clinical curative effect ,and has certain clinical value .

Objective To determine the concept of functional evaluation for children with congenital heart disease in the views of International Classification of Functioning, Disability and Health (Children and Youth Version) (ICF-CY). Methods Clinical researches on children and adolescents with congenital heart disease nearly a decade were recalled from MEDLINE/PubMed and EMBASE. The concepts extracted were linked with ICF-CY. Results 224 researches were recalled. The oncepts linked with ICF-CY in 12 first categories, 28 second categories, of which 17 items were of body function, 2 of body structure, 6 of activities and participation, and 3 of environmental factors.Conclusion ICF-CY is a useful framework for functional assessment for children with congenital heart disease. It is important to make the measurement uniformity for comparability of the researches.

Shennongjia is well known as the national treasure of traditional Chinese medicine resources at home and abroad. In order to provide Shennongjia with better protection of traditional Chinese medicine and promote the sustainable utilization of its resources, based on the specific analysis of She nnongj ia′s conservation status and
available resources, we put forward primary strategies and specific measures for the sustainable utilization framework of Shennongjia traditional Chinese medicine resources, in view of resources conservation, development, utilization, as well as the resources administration.

Objective To explore the impact of metacognitive technology psychological intervention technology on perioperative school-age children′s psychological condition, designed to find an efficient, fast method to intervene preoperative psychological condition, to eliminate their fear of emotional,coping with stress reaction in the effective time. Methods A total of 70 cases of school-age children who were treated from December 2016 to March 2017 were selected randomly and divided into the experimental group (35 cases) and the control group (35 cases). Both groups performed routine preoperative,intraoperative and postoperative nursing,and the experimental group was performed by the special person on the basis of conventional care when waiting for the operation. The changes of the fear index were compared between two groups of patients(T1),preoperative waiting(T2),pre-anesthesia(T3) and one day after surgery(T4). Results The scores of T1,T2,T3 and T4 in the experimental group were 7.000,7.929,2.686,0.971.The scores of T1,T2,T3 and T4 in the control group were 6.929,7.543,8.286 and 3.400.There was no significant difference in the fear index between the two groups at time T1 and T2 (t=0.796, 1.627, P>0.05). The fear index of T3 and T4 was significantly lower than that in the control group. The difference was statistically significant (t=298.637, 400.463, P<0.05). Conclusions The metacognitive technique can significantly improve the psychological status of the children in perioperative school age,and improve the adaptability and tolerance of the children.