OBJECTIVE:To discuss our experience of switching use of immunosuppressive agents for patients after renal transplantation.METHODS:23 patients with chronic allograft dysfunction(CAD) were treated with tacrolimus + mycophenolate mofetil instead of cyclosporine A+ azathioprine.The change of renal function and the adverse effects were observed.RESULTS:The serum creatinine(Scr) level before and after therapy conversion were 167～478 ?mol?mL-1 with a mean value of(268?78) ?mol?mL-1 and 112～346 ?mol?mL-1 with a mean value of(174?65) ?mol?mL-1,respectively,showing significant difference in the t test(P

Objective:To investigate the relationship of papillary thyroid microcarcinoma (PTMC) with serum thyroglobulin.Methods:Data of 539 patients with papillary thyroid nodule (≤1cm) in Department of Thyroid and Breast Surgery of the Second Hospital of Anhui Medical University and the Department of Oncology Surgery of Suzhou Municipal Hospital for thyroidectomy were retrospectively analyzed. All of the nodules were classified as TI-RADS 4b with ultrasound. According to the postoperative pathological results, patients were divided into PTMC group (experiment group) and benign tumor group (control group) . The PTMC patients were also divided into lymph node metastasis group (experiment group) and no lymph node metastasis group (control group) based on the cervical lymph node metastasis. Then we analyzed the relationship between thyroid stimulating hormone (TSH) , thyroglobulin antibody (TgAb) , thyroid peroxidase antibody (TPOAb) and thyroglobulin (Tg) with PTMC and lymph node metastasis by SPSS.Results:Age, TSH, Tg and TgAb were independent risk factors for PTMC, B: -0.020, 0.192, 0.026, 0.008, 95% CI: 0.962-0.998, 1.045-1.404, 1.015-1.038, 1.003-1.014, both P<0.05. The relations between PTMC and TSH, Tg and TgAb were positive, while age was in negative correlation with PTMC. Meanwhile, age and thyroglobulin (Tg) were also independent risk factors for lymph node metastasis in PTMC patients, B: -0.025, 0.014, 95% CI: 0.957-0.994, 1.008-1.021, both P<0.05. Age was negatively correlated with lymph node metastasis and Tg was positively correlated with lymph node metastasis. Tg level higher than 26.520 ng/ml indicated that the nodule was PTMC (sensitivity: 0.560, specificity: 0.719) , and Tg level higher than 36.695 ng/ml predicted lymph node metastasis in PTMC patients (sensitivity: 0.532, specificity: 0.788) . Conclusion:Tg is a sensitive serum index for identifying PTMC from benign thyroid nodule, and it is also related to lymph node metastasis in PTMC patients.

Objective To investigate the gender difference of the plasma lactic acid(LA) levels in type 2 diabetics with normal renal and hepatic function, and the effect of metformin on LA levels in the difference gender. Methods A total of 1 021 type 2 diabetic inpatients with normal renal and hepatic functions were collected,including metformin treatment group (213 males and 210 females) and metformin non-treatment group (299 males and 299 females). LA was measured with enzyme-electrode assay. Fasting plasma glucose ( FPG), creatinine ( Cr), and alanine aminotransferase ( ALT) levels were determined. Results LA level in metformin treatment group was significantly higher than that in metformin non-treatment group [ (1.32±0.53 vs 1.14±0.49) mmol/L,P<0.01],and 61 cases had hyperlactacidemia but no lactic acidosis was found. Spearman correlation analysis showed that LA level was positively associated with gender,metformin, and body mass index( BMI) apart from Cr and ALT( P<0.01). Multivariate logistic regression analysis showed that gender,Cr,ALT,and metformin were independent correlated factors of hyperlactacidemia. LA levels in females were higher than those of males in the whole group and two groups treated or not treated with metformin (all P<0. 05 ). LA levels in females were higher compared to male in Cr and ALT subgroups,as well as age subgroups,especially with age younger than 45 years old (P=0.021). Conclusions There is gender difference of lactate level in diabetic patients,and the effect of metformin on the plasma lactate levels of different gender is varied. The plasma LA level in females,especially those approaching menopause,are prone to hoist.

Objective To study the relationship between plasma creatinine and lactic acid levels in type 2 diabetic patients with normal renal function, and the effect of mefformiu administration on plasma lactic acid. Methods Blood samples were collected from 723 type 2 diabetic inpatients(275 cases treated with mefformin as treatment group and 448 without mefformin as control group). Plasma lactic acid was measured with enzyme-electrode assay. The fasting plasma glucose, fasting insulin, creatinine (Cr) , alanine aminotransferase (ALT), and HbA1C levels were also determined. Results (1) The lactic acid level in treatment group was significantly higher than that in control group [(1.33±0.57 vs 1.17±0.47) mmol/L, P<0.01] and so was the incidence of hyperlactacidemia (9.45% vs 4.91%, P<0.01). No lactic acidosis was found in all patients. (2) The correlation analysis showed that Cr, blood urea nitrogen, ALT and body mass index (BMI) were positively correlated with lactic acid in control group, and the positive correlation between Cr and lactic acid still existed (r= 0.345, P<0.01) after adjustment for ALT and BMI. (3) After being divided by 20 μmol/L Cr in control group, lactic acid levels in subgroup increased with the Cr levels, especially when Cr was over 90 μmol/L. The Cr cutpoint for predicting lactatemia was 95.35 μmol/L. Conclusion It is safe to administrate metformin in type 2 diabetic patients with normal renal function, along with low risk of lactic acidemia. The incidence of lactic acidemia may increase when plasma Cr level reaches 95.35 μmol/L,

Objective To summarize the techniques of anatomical liver resection for the treatment of hepatocellular carcinoma(HCC).Methods The clinical data of 125 patients with solitary HCC who underwent anatomical liver resection at the Zhongshan Hospital from January 2005 to December 2006 were retrospectively analysed.The inflow and outflow of hepatic segments to be resected were selectively clamped,then the main branches of portal vein and hepatic artery were ligated,and the ischemic hepatic segments were resected en bloc.Kelly forceps were used to crash and clamp the liver cut surface.The stumps of left and right hepatic ducts were continuously sutured with Prolene sutures.For tumors with the size above 10 cm in diameter,hepatectomy with anterior approach and liver hanging maneuver were adopted.Bile leakage was checked by injecting methylene blue or covering a gauze on the liver cut surface.Results The mean blood loss of all patients was 250 ml(100-6000 ml),and 32 of them needed blood transfusion.The morbidity was 23%(29/125).No patient died within 30 days after the operation,and 6%(5/83)of patients were found with residual tumor by postoperative arteriography.Conclusion Anatomical liver resection may improve the safety of operation,prevent the injury of great vessels and thus improve the efficacy.

Objective To study the impact of implanted thermoseeds of magnetic induction hyperthermia on radiation dose distribution. Methods To simulate irradiation, an anthropomorphic phantom and three-dimensional treatment planning system were used. The impact of thermoseeds on radiation dose distribution was evaluated. Results The change of absorbed dose caused by the implantated thermoseeds was less than 1.5%. Conclusions The impact of implanted thermoseeds on radiation dose distribution is small and comes up to the requirements that the total target dose uncertainty must be less than 5%. Therefore, the impact of thermoseeds on the absorbed dose in tissue can be ignored in clinical practice.

Objective To evaluate the clinical significance of glycated albumin (GA), a parameter in reflecting recent glycemic control, in patients with impaired glucose regulation (IGR) and newly diagnosed diabetes mellitus. Methods From January to June 2007, 516 subjects who accepted oral glucose tolerance test (OGTT) in out-patient department were randomly enrolled, including 130 with normal glucose regulation (NGR), 154 with IGR and 232 with diabetes mellitus. The fasting plasma glucose (FPG), 0.5 h plasma glucose (PG), 1hPG, 2hPG, 3hPG after glucose loading, HbA1c and GA were measured in each subject. The correlation between GA and the other parameters were analyzed. Results There were significant differences in the values of GA among NGR, IGR and diabetes mellitus groups (all P < 0.01), but no difference in the values of HbA1c between NGR group and IGR group (P > 0.05). GA was positively correlated with HbA1c (r = 0.75, P < 0.01). Stepwise regression analysis showed that FPG, 2hPG and body mass index were the major independent contributing factors. Conclusion The combination of plasma glucose with GA measurement may be helpful in evaluating the status of glucose metabolism.

OBJECTIVE: To discuss whether a reduced dose of CsA was allowed yet without increase risk of rejection, and whether the incidence of CsA-related side effects be reduced while the curative effects be enhanced by combined use of Cyclosporine (CsA), prednisone and Mycophenolate Mofetil (MMF) in patients after renal transplantation. METHODS: In this comparative study, 213 renal allograft recipients receiving routine dose of CsA were compared with 176 cases receiving low dose CsA. RESULTS: The two groups showed no significant differences in renal function, incidence of rejection and human/kidney survival rate. However, the low dose CsA group showed a better total curative efficacy and significantly fewer incidences of ADRs. CONCLUSION: CsA, MMF and Pred used concomitantly in patients after renal transplantation allows for a reduced dose of CsA yet without increase the risk of acute rejection if with enough dose of MMF.

Objective Recently, The incidence of fatty liver is increasing , with the improvement of people′s living standard. We here established an available model with non-alcoholic fatty liver disease in rabbits and then studied its sonographic findings . Methods Forty male Japanese rabbits were randomly divided into 2 groups:control group and model group.The rabbits in model group were fed with high-fat diet for the establishment of the model of non-alcoholic fatty liver disease.The rabbits in control group were fed with standard diet. At the baseline, 12th, 16thand 20th week , all the livers in 2 groups were scanned by ultrasonography, and at the end of 20 th week, all the rabbits in 2 groups were killed for pathological analysis. Results Both the ultrasonography and in pathology demonstrated the successful establishment of non-alcoholic fatty liver models.The result of study demonstrated significant differences (P<0.05).At the 12th week, all of the 19 livers in model group showed fatty livers in sonography:8 low-, 9 middle-and 2 high-grade.The degree of steatosis aggravated pro-gressively with modeling time.Most of livers showed middle-grade fatty at the 16th week, and at the 20th week, they all demonstrated middle-or high-grade fatty liver:10 middle-and 9 high-grade, furthermore, ascites occurred in 3 cases.The pathological results were consistent with the findings of sonography, and fibrosis were observed in pathology. Conclusion Animal model with non-alcoholic fatty liver disease in rabbits can be established by high-fat diet.Besides, ultrasonography is a good method to monitor the establishment of the model .

Objective The incidence of alcoholic fatty liver increases year by year in recent years .The aim of this study was to establish an animal model of AFL to investigate the pathogenesis of hepatic fibrosis . Methods This study involved 40 male Japa-nese rabbits aged (17.01 ±1.54) d and weighing 1.00-1.52 kg, which were equally randomized to an experimental group and a control group.The animals in the former group received lavage of 10 mL of 50%ethanol twice a day, with normal feedstuff and water, while those in the control group received normal feedstuff and water only .We performed ultrasonography for dynamic liver presentation before and at 12, 16, and 20 weeks after feeding, followed by pathological observation of the livers . Results After 12 weeks of eth-anol garage , fatty liver was observed in 18 of the rabbits and it deteriorated with the prolonged time of administration . The body weight was significantly decreased in the experimental rabbits as com-pared with the controls at 16 weeks ([2.48 ±0.30] vs [2.78 ± 0.15] kg, P<0.05) and 20 weeks ([2.61 ±0.44] vs [3.10 ± 0.13] kg, P<0.05).Ultrasound and pathological grading showed 1 mild, 3 moderate, and 13 severe cases of fatty liver in the experimen-tal group, but none in the control , and pathological examination re-
vealed similar results (1 mild, 4 moderate, and 12 severe cases of fatty liver) in the former group.At 20 weeks, alcoholic fatty liver was found mainly in the S3-S4 stage. Conclusion Alcoholic fatty liver models could be successfully established in rabbits by etha-nol garage and ultrasonography is useful for monitoring the development and progression of the condition .