AIM:To investigate the effect of renal denervation ( RDN) by radiofrequency catheter ablation on the expression of aquaporins ( AQP) in dog kidneys .METHODS:Adult Chinese Kunming dogs ( n=12 ) were randomly divided into RDN group and control group (6 for each group).The dogs in RDN group underwent bilateral RDN using ra-diofrequency catheter ablation , and radiofrequency catheter was positioned in bilateral renal artery without ablation in con -trol group.The levels of norepinephrine (NE) and AQP1~3 in the renal tissues were detected 1 month after RDN, and blood pressure (BP) measurements were performed at baseline and 1 month after RDN.RESULTS: The level of NE in RDN group was significantly lower than that in control group (P<0.01).The expression of AQP1~3 in the renal cortex and medulla was lower in RDN group than that in control group .RDN also caused a substantial BP reduction (P<0.05). CONCLUSION:RDN substantially decreases the tissue levels of NE and AQP in dog kidneys , and also decreases BP sig-nificantly , which might be involved in the mechanism of BP reduction by RDN .Renal sympathetic nerve plays an excitatory role in the regulation of AQP in the kidney.

Targeting the common fact that colleges and universities of traditional Chinese medicine neglect management post practice,are lack of cutting-edge,cross-disciplinary and methodological courses,fail to reflect the traditional Chinese medicine's singularity and update courses slowly during the process of cultivating their graduate students,Heilongjiang University of Chinese Medicine innovates its culture system of graduate student in related major.It is also devoted to developing problem-based learning,introducing bitutor system,reforming course system,which may hopefully improve their graduate students' innovative thoughts and abilities,strengthen their innovative knowledge theory system to finally discover an appropriate reform model for the culture system which can be perfectly replicable.

BACKGROUND: Removal of immunosuppressants in patients with recurrent tumor in long-term following organ transplantation is always a hot controversial point in academic circles. To further elevate clinical efficiency, people began to invent new immunosuppressant and studied immune efficiency of various immunosuppressant component. They tried to reduce the application of cyclosporin A (CsA).OBJECTIVE: To analyze the CsA safe withdrawal of a case of kidney recipients, at 18 years after renal transplantation, who developed bladder carcinoma and renal pelvic carcinoma at 11 years and 18 years after transplantation, respectively. METHODS: After identified diagnosis, we performed transurethral resection of bladder tumor (TURBt) and total nephroureterectomy merobladder excision. Pathologic examination revealed grade Ⅰ-Ⅱ of bladder and renal pelvic transitional cell carcinoma. After the operation, patient was treated with immune suppression program of CsA withdrawal gradually in 12 days.Within 12 days, 5 mg CsA was decreased every 3 days, and complete withdrawal was done at 12 days. The dosage of azathioprine tablets and prednisone acetate tablets was not changed. Serum creatinine levels were rechecked every 3 days during drug withdrawal, and blood pressure, urine volume, physical symptom of patients and ultrasound of transplanted kidney were observed.RESULTS AND CONCLUSION: During the three months of CsA withdrawal, the blood creatinine levels were from 65 to indicated that the CsA gradually withdrawal of a case of kidney recipients after renal transplantation, who developed transitional cell carcinoma and was performed transurethral resection of bladder tumor (TURBt) and total nephro- ureterectomy merobladder excision, was safe. No tumor relapse or diversion was found.

OBJECTIVE: Tacrolimus is widely used in organ transplant. However, the long-term effects of tacrolimus on Asian, in particular in Chinese people, are few. The aim of this study is to evaluate the efficacy and safety of long-term curative effect of tacrolimus used in kidney transplantation patients in China.DATA SOURCES: Electronic and manual retrieve of Medline database, Chinese journal full-text database, Cochrane library, and CEBM/CCD, and relevant medical journals in China were applied.DATA SELECTION: Published randomized controlled trials on tacrolimus in kidney allograft recipient were retrieved, and the data were underwent Meta analysis. Odds ratio (OR) and its 95% confidence interval (CI) were used as the measurement parameter of efficacy comparison. The statistical analyses were performed using Stata software.MAIN OUTCOME MEASURES: ①The survival ratio of patient/kidney after 1 year. ②The survival ratio of patient/kidney after 3 years. ③Rejection ratio after 3 years. ④Infection rate after 3 years. ⑤Incidence of liver dysfunction after 3 years. ⑥Blood glucose disorder after 3 years.RESULTS: A total of 3 trials were eligible for the inclusion efficacy, including 3 Chinese trials and 0 foreign trials. Results of meta-analysis indicated that tacrolimus prevented the recipients of kidney transplantation from rejection effectively in three years [OR=0.40, 95%CI (0.27-0.61), P < 0.000 1]. Tacrolimus prevented the recipients of kidney transplantation from impaired liver function in three years [OR=0.28, 95%CI (0.15-0.52), P < 0.000 1]. No statistical difference of the 1-year and 3-year survival rate of patients/ kidney was found in the patients between group tacrolimus and group cyclosporine. Statistical difference of blood glucose disorder were found in the patients between group tacrolimus and group cyclosporine [OR=2.39, 95%CI (1.41-4.05), P=0.001].CONCLUSIONS: Tacrolimus prevented the recipients of kidney transplantation from rejection and impaired liver function effectively in three years in China. No statistical difference of the 1-year and 3-year survival rate of patients/kidney was found in the patients between two groups. In addition, the main side effect of tacrolimus is blood glucose elevation.

Objective:This study aimed to investigate the functional and aesthetical outcomes after index pollicization for severe congenital thumb hypoplasia.Methods:From June 2010 to November 2018, 26 patients (29 hands) with Manske modified Blauth type ⅢB-V thumb hypoplasia who were admitted to Department of Hand Surgery, Beijing Ji Shui Tan Hospital were treated with index pollicization. Thumb abduction angles, Kapandji score, pinch forces, interphalangeal and metacarpophalangeal ranges of motion were measured. The stability of carpometacarpal joint was checked. Goldfarb function score and Likert scale score were used to evaluate overall function of thumb. Whether new first metacarpal’s physeal closure presence was observed on X-ray film. Postoperative complications were recorded. The patients’guardian’s and follow-up doctor’s subjective satisfactions on thumb appearance and function were surveyed. The correlation between guardian’s satisfaction and objective indicators, the differences between guardian’s and doctor’s satisfactions, the difference between operation satisfaction before and after 3 years old were analyzed.Results:Among 26 patients(4 type ⅢB, 16 type Ⅳ, and 9 type V), there were 19 males and 7 females with an average age of 37 months (range: 15-89 months) during surgery, including 8 left hands, 15 right hands and 3 bilateral hands. The average follow-up was 42 months. Average thumb radial abduction was 46.2°, average palmar abduction was 34.1°, and average Kapandji score was 7.1. Average angle of interphalangeal joint extension was 3.4°, flexion 40.7°, metacarpophalangeal joint extension 4.1°, flexion 38.6°. The average pinching forces (key pinch, tip pinch and tripod pinch) were 0.5 kg, 0.8 kg and 1.2 kg respectively. All carpometacarpal joints were stable. The average Goldfarb score was 4. The average Likert scale was 22. All epiphyses were open. First web contracture and superficial skin necrosis were respectively observed in 1 and 6 cases. There was no correlation between the guardian’s satisfaction and the objective indicators. The guardian’s satisfaction on thumb appearance and function was significantly lower than that of doctors’. There was no significant difference in guardian’s and physician’s satisfaction between patients before and after 3 years old.Conclusions:Satisfactory functional outcomes can be obtained after index pollicization for patients with Manske modified Blauth ⅢB-V thumb hypoplasia, with weak strength of thumb opposition and flexion. The subjective satisfaction of doctors was higher and that of guardians was lower.

Objective:This study aimed to investigate the functional and aesthetical outcomes after index pollicization for severe congenital thumb hypoplasia.Methods:From June 2010 to November 2018, 26 patients (29 hands) with Manske modified Blauth type ⅢB-V thumb hypoplasia who were admitted to Department of Hand Surgery, Beijing Ji Shui Tan Hospital were treated with index pollicization. Thumb abduction angles, Kapandji score, pinch forces, interphalangeal and metacarpophalangeal ranges of motion were measured. The stability of carpometacarpal joint was checked. Goldfarb function score and Likert scale score were used to evaluate overall function of thumb. Whether new first metacarpal’s physeal closure presence was observed on X-ray film. Postoperative complications were recorded. The patients’guardian’s and follow-up doctor’s subjective satisfactions on thumb appearance and function were surveyed. The correlation between guardian’s satisfaction and objective indicators, the differences between guardian’s and doctor’s satisfactions, the difference between operation satisfaction before and after 3 years old were analyzed.Results:Among 26 patients(4 type ⅢB, 16 type Ⅳ, and 9 type V), there were 19 males and 7 females with an average age of 37 months (range: 15-89 months) during surgery, including 8 left hands, 15 right hands and 3 bilateral hands. The average follow-up was 42 months. Average thumb radial abduction was 46.2°, average palmar abduction was 34.1°, and average Kapandji score was 7.1. Average angle of interphalangeal joint extension was 3.4°, flexion 40.7°, metacarpophalangeal joint extension 4.1°, flexion 38.6°. The average pinching forces (key pinch, tip pinch and tripod pinch) were 0.5 kg, 0.8 kg and 1.2 kg respectively. All carpometacarpal joints were stable. The average Goldfarb score was 4. The average Likert scale was 22. All epiphyses were open. First web contracture and superficial skin necrosis were respectively observed in 1 and 6 cases. There was no correlation between the guardian’s satisfaction and the objective indicators. The guardian’s satisfaction on thumb appearance and function was significantly lower than that of doctors’. There was no significant difference in guardian’s and physician’s satisfaction between patients before and after 3 years old.Conclusions:Satisfactory functional outcomes can be obtained after index pollicization for patients with Manske modified Blauth ⅢB-V thumb hypoplasia, with weak strength of thumb opposition and flexion. The subjective satisfaction of doctors was higher and that of guardians was lower.

Objective:To investigate the clinical effect of free fibular head epiphysis transplantation pedicled with the recurrent branch of the anterior tibial artery in the treatment of children with Bayne-Klug Ⅱ-Ⅲ congenital radial dysplasia.Methods:From February 2013 to September 2018, we retrospectively reviewed and analyzed our prospective database of four patients with Bayne-Klug type Ⅱ-Ⅲ congenital radius dysplasia referred to Beijing Jishuitan Hospital for consideration of free fibular head epiphysis transplantation. All children underwent surgical treatment by stages: (1) Before surgery, the radial soft tissue and wrist joint were gradually stretched by massage and traction braced to maximize the radial space. (2) A free fibular head pedicled with the recurrent branch of the anterior tibial artery was harvested from the ipsilateral lower limb and transferred as a vascularized fibular head composite flap for reconstructing the stable structure of the distal radius and wrist joint. (3) At least six months after the procedure, pollicization was performed on Blauth type Ⅳ and Ⅴ. The treatment effect was evaluated by measuring the radial deviation angle, the growth length of the fibula, and the ratio of the radius/ulna length.Results:A total of 4 boys with right side deformity were enrolled. The ages of the patients ranged from 16 to 62 months, with an average of 30.5 months. The post-operative follow-up period was 19 to 78 months, with an average of 40.5 months. Three children with Blauth type Ⅳ or Ⅴ thumb dysplasia were performed with pollicization about one year after free fibular head epiphysis transplantation. All the grafted bones healed; the radial deviation angle was corrected by an average of 24°; the reconstructed distal radius grew longer, with an average increase of 13.2% when the plate was removed compared with six weeks post-operatively; the ratio of the radius/ulna was an average increase of 13.3% compared with preoperative.Conclusions:The use of fibular head epiphyseal flap pedicled with the recurrent branch of the anterior tibial artery is a good method for the treatment of Bayne-Klug type Ⅱ-Ⅲ radius dysplasia. The reconstructed distal radius has the ability to grow longitudinally, which can effectively correct the radial deviation and avoid the further development of the deformity.

Objective:To introduce a new design of double rotation flap in the treatment of congenital clasped thumb. The clinical effect of this new method to deepen the thumb-index webspace and release the palmar contracture of the first metacarpophalangeal joint (MCP) was assessed.Methods:Retrospective analysis was performed on the data of children with congenital clasped thumb treated by hand surgery in Beijing Jishuitan Hospital from January 2017 to December 2020. All patients presented with a narrow thumb-index webspace and palmar contracture at the first MCP joint. The double rotation flap contains two components, one of which was harvested from the radial-dorsal side of the index and transferred to widen the first webspace. The volar defect was mainly covered by the rotation flap transposed from the ulnar-dorsal side of the thumb. The extensor pollicis brevis was tightened or reconstructed based on the various developmental abnormality and the intrinsic muscle contracture was released to facilitate passive extension of the first MCP joint. Postoperative plaster immobilization was applied for one month and regular rehabilitation was conducted afterward. The survival of the flaps and the healing of the donor sites were followed up, the effect of the first webspace and palmar contracture release and thumb function were evaluated, and the parents’ satisfaction was investigated.Results:A total of 10 children with 11 affected thumbs (4 on the left side and 7 on the right side) were enrolled, with an average age of 26 months (11-36 months). All transposition flaps were survived without tip necrosis. Based on Gilbert’s method of assessment of thumb function, excellent or good improvement was achieved in the abduction of thumb (42°, 38°-43°) and extension of the MCP joint (1.6°, -5°-10°). All parents were satisfied with the appearance and function of the affected hand.Conclusions:The double dorsal-lateral rotation flap can provide sufficient width and depth of the first webspace and adequate coverage of the volar defect of the first MCP joint. This simple design is a reliable procedure for the treatment of congenital clasped thumb.

Objective:To investigate the clinical effect of free fibular head epiphysis transplantation pedicled with the recurrent branch of the anterior tibial artery in the treatment of children with Bayne-Klug Ⅱ-Ⅲ congenital radial dysplasia.Methods:From February 2013 to September 2018, we retrospectively reviewed and analyzed our prospective database of four patients with Bayne-Klug type Ⅱ-Ⅲ congenital radius dysplasia referred to Beijing Jishuitan Hospital for consideration of free fibular head epiphysis transplantation. All children underwent surgical treatment by stages: (1) Before surgery, the radial soft tissue and wrist joint were gradually stretched by massage and traction braced to maximize the radial space. (2) A free fibular head pedicled with the recurrent branch of the anterior tibial artery was harvested from the ipsilateral lower limb and transferred as a vascularized fibular head composite flap for reconstructing the stable structure of the distal radius and wrist joint. (3) At least six months after the procedure, pollicization was performed on Blauth type Ⅳ and Ⅴ. The treatment effect was evaluated by measuring the radial deviation angle, the growth length of the fibula, and the ratio of the radius/ulna length.Results:A total of 4 boys with right side deformity were enrolled. The ages of the patients ranged from 16 to 62 months, with an average of 30.5 months. The post-operative follow-up period was 19 to 78 months, with an average of 40.5 months. Three children with Blauth type Ⅳ or Ⅴ thumb dysplasia were performed with pollicization about one year after free fibular head epiphysis transplantation. All the grafted bones healed; the radial deviation angle was corrected by an average of 24°; the reconstructed distal radius grew longer, with an average increase of 13.2% when the plate was removed compared with six weeks post-operatively; the ratio of the radius/ulna was an average increase of 13.3% compared with preoperative.Conclusions:The use of fibular head epiphyseal flap pedicled with the recurrent branch of the anterior tibial artery is a good method for the treatment of Bayne-Klug type Ⅱ-Ⅲ radius dysplasia. The reconstructed distal radius has the ability to grow longitudinally, which can effectively correct the radial deviation and avoid the further development of the deformity.

Objective:To introduce a new design of double rotation flap in the treatment of congenital clasped thumb. The clinical effect of this new method to deepen the thumb-index webspace and release the palmar contracture of the first metacarpophalangeal joint (MCP) was assessed.Methods:Retrospective analysis was performed on the data of children with congenital clasped thumb treated by hand surgery in Beijing Jishuitan Hospital from January 2017 to December 2020. All patients presented with a narrow thumb-index webspace and palmar contracture at the first MCP joint. The double rotation flap contains two components, one of which was harvested from the radial-dorsal side of the index and transferred to widen the first webspace. The volar defect was mainly covered by the rotation flap transposed from the ulnar-dorsal side of the thumb. The extensor pollicis brevis was tightened or reconstructed based on the various developmental abnormality and the intrinsic muscle contracture was released to facilitate passive extension of the first MCP joint. Postoperative plaster immobilization was applied for one month and regular rehabilitation was conducted afterward. The survival of the flaps and the healing of the donor sites were followed up, the effect of the first webspace and palmar contracture release and thumb function were evaluated, and the parents’ satisfaction was investigated.Results:A total of 10 children with 11 affected thumbs (4 on the left side and 7 on the right side) were enrolled, with an average age of 26 months (11-36 months). All transposition flaps were survived without tip necrosis. Based on Gilbert’s method of assessment of thumb function, excellent or good improvement was achieved in the abduction of thumb (42°, 38°-43°) and extension of the MCP joint (1.6°, -5°-10°). All parents were satisfied with the appearance and function of the affected hand.Conclusions:The double dorsal-lateral rotation flap can provide sufficient width and depth of the first webspace and adequate coverage of the volar defect of the first MCP joint. This simple design is a reliable procedure for the treatment of congenital clasped thumb.