Objective:To clarify the relationship between postoperative tumor recurrence and the type and dosage of immunosuppressants in patients undergoing liver transplantation.Method:A retrospective analysis was conducted on the clinical data of patients who underwent liver transplantation for liver cancer from September 2007 to January 2019 at the Department of Hepatobiliary Surgery, First Affiliated Hospital of Chongqing Medical University. According to whether there was tumor recurrence after liver transplantation, the patients were divided into the case group and the control group. The etiology, alpha-fetoprotein level, Child-Pugh score, model for end-stage liver disease (MELD) score, and cancer nodules, number of tumors, diameter of largest cancer nodule, microvascular infiltration (MVI), large vessel infiltration, Edmondson grade of tumor differentiation, postoperative immunosuppression regimen, and blood trough concentration of tacrolimus or cyclosporine were compared between the two groups. The effects of calcineurin inhibitor (CNI) exposure in groups of patients on tumor recurrence were compared, and statistically significant factors were included in the Cox regression analysis. Using the BCLC staging standard of liver cancer, all the subjects were stratified, and the influence of CNI exposure on tumor recurrence was further analyzed.Results:This study included 50 patients. There were 15 patients in the case group, aged (45.8±8.2) years, with 13 males (86.7%). There were 35 patients in the control group, aged (45.4±12.0) years, 31 males (88.6%). The diameter of the largest cancer nodule in the case group was significantly larger than that in the control group [(5.9±3.0) cm vs (3.5±1.8) cm, P<0.05]. The tacrolimus exposure levels in the case group at 14 d after operation were significantly higher than the control group[(11.7±7.7)ng/ml vs (5.9±3.0)ng/ml, t=2.48], 1 month after operation [(12.2±4.5) ng/ml vs (7.8±4.3) ng/ml, t=2.82], 9 months after operation [(6.9±4.0) ng/ml to (4.7±2.0) ng/ml, t=2.21] and the area under the curve at 1 year after operation [(100.1±21.1) vs (74.4±19.2), t=3.66], all P<0.05. Survival analysis showed that the cumulative tumor-free survival rate of the CNI high-exposure group was significantly lower than that of the CNI low-exposure group (52.2% vs 85.2%, χ 2=6.52, P<0.05). Multivariate analysis using the Cox proportional hazards regression model showed that the largest cancer nodule diameter ( RR=1.23, 95% CI: 1.01-1.60) and high CNI exposure ( RR=4.02, 95% CI: 1.10-14.74) were independent risk factors for tumor recurrence after liver transplantation. Stratified analysis showed that of the 17 patients with BCLC stage B, 6 patients (66.7%) with high CNI exposure developed tumor recurrence, while only 1 patient (12.5%) with low CNI exposure developed tumor recurrence. The difference was statistically significant ( P<0.05). Survival analysis showed that the cumulative tumor-free survival rate of patients with CNI high-exposure was significantly lower than that of patients with CNI low-exposure (33.3% vs 87.5%, χ 2=5.74, P<0.05). Of the 8 patients with BCLC stage C, 4 patients developed tumor recurrence with CNI high-exposure (100.0%). There was no tumor recurrence in patients with low CNI exposure. The difference between groups was statistically significant ( P<0.05). Survival analysis showed that the cumulative tumor-free survival rate of patients with high CNI exposure was significantly lower than that of low CNI exposure (0 vs 100.0%, χ 2=6.80, P<0.05). Conclusions:Tumor recurrence after liver transplantation was not significantly related to the type of immunosuppressant used. High CNI exposure was a risk factor for tumor recurrence after liver transplantation.

Recently,there is a gradual increase in the incidence of hyperlipidemic pancreatitis with high serum triglyceride (TG) levels.The treatments include general measures,lipid-lowering drugs,blood purification,low molecular weight heparin and insulin,traditional medicine,improving microcirculation,surgical therapy and gene therapy.The prevention of recurrence of hyperlipidemic pancreatitis is different from other types of pancreatitis.

BACKGROUND:With the development of minimal y invasive technique, more and more forearm fracture, especial y in children, was treated by elastic stable intramedul ary nailing. Recently, elastic stable intramedul ary nailing was also used in elder children, even adults. In particular, this technique has obtained good curative effects for open fracture and unstable fracture. OBJECTIVE:To evaluate the clinical effectiveness and safety of elastic intramedul ary nail and plate fixation for double fracture of forearm using evidence-based medicine. METHODS:We retrieved PubMed, Embase, Cochrane Library, China Biology Medicine, VIP, China National Knowledge Infrastructure, WanFang, and other electronic databases. The quality of the included studies was assessed using Cochrane Systematic Review. The analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION:A total of 7 randomized control ed trials involving 468 cases were included. The results of meta-analyses showed that compared with plate fixation group, effective rate was higher in the titanium elastic nail group (P<0.000 1), the time of fracture healing was shorter (P<0.000 01), and the hospitalization time was shorter (P<0.000 01). In the aspect of adverse reactions, incidence of refracture (P=0.03) and breakage of internal fixation (P=0.03) was significantly lower. These indicated that compared with plate fixation, titanium elastic nail can improve the total effective rate, shorten the time of fracture healing on X-ray and the hospitalization time, at the same time, can effectively reduce the complications of refracture and breakage of internal fixation.

The phytase was extracted from solid state leavening of Trichoderma Viride LH374.The crude product was purified by(NH_4)_2SO_4 precipitation,gel filtration and ion exchange chromatography.The purified phyatse was 13.3 times of the raw products,and the extraction ration was 27.1%.The study on the enzymology of phyatse showed that the optimal temperature and pH were 55℃ and 6.0,respectively.The Km value of the phytase was 0.15mmol/L.

20% increase in serum creatinine over the last 6 months or progression to the range of 176-308?mol/L.Patients underwent abrupt cessation of cyelosporine and sirolimus maintenance at 1-2 rag/day after administration of 4-6 mg as first loading dose.Concomitant immunosuppression remained unchanged during conversion.Results Targeted sirolimus level was 4-8 ng/mL.Serum creatinine was dropped from pre-conversion level of(242.15?73.04)?mol/L to(188.32?58.96)?mol/L and (173.36?58.08)?mol/L at 3rd and 6th month respectively(P

Dendritic cells (DCs) are uniquely well-equipped antigen (Ag)-presenting cells. This function of DCs, coupled with their remarkable plasticity, renders them attractive therapeutic targets for immune modulation. Recent data have demonstrated a promising role for pharmacologic treatment as a means of generating potent regulatory DCs. Herein, the evidence that the potential of regulatory DC the-rapy is considerable and that there are compelling reasons to evaluate it in the setting of organ transplantation in the near future are discussed in this paper.

Objective To evaluate the effects of different positions on cerebral blood flow in patients undergoing laparoscopic surgery.Methods Thirty patients of both sexes,aged 23-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic surgery,were included.Patients' position was changed using a random number table after induction of anesthesia.Patients were placed in the supine position and tilted 15° head-up or 15° head-down,and the parameters of the middle cerebral artery were monitored using the transcranial Doppler ultrasound.After admission to the operating room (baseline),after induction of anesthesia and before pneumoperitoneum,in the supine position,at head-up tilt and at head-down tilt,the mean blood flow velocity,pulsatility index,resistance index,mean arterial blood pressure (MAP) and heart rate were recorded.Results Compared with the baseline in the supine position,the MAP and bilateral mean blood flow velocity were significantly decreased at head-up tilt,and the MAP and bilateral pulsatility and resistance indices were significantly increased at head-down tilt (P＜0.05).Conclusion During laparoscopic surgery,head-up tilt can lead to a decrease in cerebral blood flow,and head-down tilt exerts no effect on cerebral blood flow.

Objective To explore the differences and development of executive function(EF) between cerebral palsy(CP) children and normal children. Methods Forty-eight 4 ～6 years old CP children and fiftyeight normal children were tested by "cool" and "hot" EFs. Results There were significant differences between "cool" EF of CP children(18.34±14.31) and normal children(6.94 ±3. 18) ( t = 3. 83, P<0.01 ) ;and there were significant differences between "hot" EF of CP children(279.67 ±330. 18) and normal children(709.31 ± 304. 13)( t = -4.93, P< 0.01). There were significant age differences on the "cool" EF ( F=8.689, P< 0.01) and "hot" EF ( F=3. 833, P<0.05) of CP children. There were significant age differences on the "cool" EF ( F= 15.469, P<0.01) and on the "hot" EF ( F=8.470, P<0.01) of normal children. There was negative correlation between "cool" EFs and "hot" EFs( r= -0.440, P<0.01). Conclusion "Cool" and "hot" EFs of CP children are lower than those of normal children. "Cool" and "hot" EFs can develop from 4 to 6 years old,but the development of EFs are not absolutely consistent between CP children and normal children. There is correlation between "cool" and "hot" EFs in patients with CP,but not dissociation.

[Abstract ] Objective To compare the accuracy between regular computed tomography colonography (CTC)and dual-energy CTC in lesion detection.Methods Twenty-eight patients with clinical suspicious space occupying lesions of the colon were selected.All patients were underwent dual-energy mode contrast-enhanced CT scan and the data were reconstructed with colonography and dual-energy iodine maps methods.The diameter,enhanced computed tomography (CT)value and iodine value were measured.The results of colonoscopy and pathology were taken as gold standard.The sensitivity, specificity,accuracy,positive predictive value and negative predictive value of regular CTC and dual-energy CTC were compared.Variance analysis was performed for measurement data comparison among groups and chi-square test was used for count data analysis.Results Among 28 patients,colorectal lesions were detected in 24 cases by regular CTC,of which four cases were false-positive and one case was false-negative confirmed by colonoscopy and pathology.Colorectal lesions were detected in 20 cases by dual-energy CTC,of which no false-positive and one case was false negative confirmed by colonoscopy and pathology.The contrast enhanced CT value of polyps,adenoma,adenocarcinoma and stool was (38.54± 6.82),(49.16±7.31 ),(52.61 ±5 .93 )and (34.00±1 .41 )Hu,respectively.The enhanced value of adenoma and adenocarcinoma was significantly higher than that of polyps and stool,the differences were statistically significant among groups (F = 10.760,P = 0.001 ).There was no significant difference between polyps and stool (t=1 .44,P =0.188).The sensitivity of regular CTC and dual-energy CTC in lesion detection was 95 .6% (95 %cofidence interval(CI ):77.9%-99.2%)and 95 .6% (95 %CI :77.9%-99.2%),respectively.The specificity was 42.8% (95 %CI :15 .4%-93.5 %)and 100.0% (95 %CI :47.9%-100.0%).Conclusion Compared with traditional CTC,dual-energy CTC would distinguish lesions from stool,help differentiate between benign and malignant tumors and further increase the accuracy of CTC diagnosis.

Objective To investigate the relationship between source memory and item memory in children,adult and the elderly Chinese,to test the hypothesis that neuronal substrate of source memory includes frontal lobe,and that source memory and item memory were dissociated in child and the elderly.Methods A neuropsyehological battery was established to measure the performance of item memory and source memory.Child,adult and the health elderly Chinese(40 cases in each group, respectively)were enrolled.The performance of child and the elderly Chinese were compared with that of the adults,and were also analyzed among the groups to check the dissociation between the performance of item and source memory.Results Compared with the adults,the source memory in children(I value:0.87?0.08 vs.0.73?0.13,P＜0.01)were impaired,but not found in item memory(Pr value:0.73?0.14 vs.0.74?0.11,P＞0.05).The elderly Chinese was impaired in both item(Pr value:0.66?0.15,P＜0.05)in source memory(I value:0.68?0.13,P＜0.01).Double dissociation between item and source memory was found in the child and the elderly.Conclusions The evidence of double dissociation between item and source memory within child and the elderly supports the dual-process model of source and item memory.These findings also support that frontal lobe involves in source memory,the indicators of source memory damage is early behavior marker for mild cognitive impairment or early Alzheimer disease.