ObjectiveThe purpose of this study was to assess the efficacy,safety and optimal dose of tacrolimus monotherapy in patients with refractory lupus nephritis(LN) who were resistant to cyclophosphamide(CYC).MethodsA total of 14 LN patients (2 men and 12 women) with persistent proteinuria who were resistant to CYC treatment more than 8 g for half a year were enrolled.Tacrolimus was initiated at 2 mg/d (patient weight＜60 kg) or 3 mg/d(patient weight≥60 kg) which was administered in two divided doses.Prospective data on daily proteinuria,serum album level and serologic lupus activity were collected and followed for 6 months.ANOVA and Pearson correlation analysis were used for statistical analysis.Results Mean age at baseline was(30±9) years.Mean urinary protein decreased significantly from(6.2±5.1) g at baseline to (1.1±0.9) g at 6 months (F=16.21,P＜0.01).Mean serum album level increased significantly from (27.9±9.7) g/L at baseline to(37.8±2.2) g/L at 6 months(F=16.71,P＜0.01 ).Complete or partial response was observed in 86％ of patients receiving tacrolimus therapy.The effective dosage in this study was 0.03-0.06mg·kg-1·d-1 of the patients who had complete response or partial response to tacrolimus.The tacrolimus level in partially and completely responding patients was less than 3 ng/ml.There was no significant difference among blood tacrolimus levels of complete,partial,and no response patients [(1.6-±0.4),(2.0±0.6) and (22±1.1) ng/nl],respectively).No definite correlation was found between efficacy and tacrolimus level.Tacrolimus was well tolerated at current dose,besides one with new onset hypertension and one with alopecia.ConclusionOur results suggest that tacrolimus at low dosage and serum level is potentially effective and safe for the treatment　of patients with LN and persistent proteinuria resistant to CYC.The optimal dosage of tacrolimus for LN may　be 0.03-0.06 mg·kg-1·d-1.

ObjectiveTo introduction of perforator flaps,muscle flaps pedicled by descending branch of lateral circumflex femoral artery,method and their clinical application that multiple soft tissue defects of hand are repaire by muliplefoliated tissue flap only branch lateral circumflex femoral artery.MethodsFifteen patients with multiple soft tissue defects of hand were repaired muliplefoliated tissue flap only pedicled bydescending branch lateral circumflex femoral artery.At first,the anterolateral thigh perforator flap was designed and harvested according to the soft tissue defects of hand, then the descending branch lateral circumflex femoral artery was dissected at the same time the segmented perforator flap,fascia lata flap,rectus femoris muscle flap, vastus lateralis muscle flap, vastus intermedius muscle flap and distal spatium intermusculare flap were harvested in need according to distance among soft tissue defects.The muliplefoliated tissue flap was harvested only pedicled by descending branch lateral circumflex femoral artery, at last muscle flaps and fascia lata flaps were covered by skin graft, so the multiple soft tissue defects of hand were repaired in one time.ResultsNo vascular crisis happened. All skin grafts survived well, the contour of all repaired soft tissue defects was good and protective feeling was recovered by skin grafts of all flaps. All cases were got follow-up and the range was from 6 to 20 months(the average was 8.7 months).Wound of donor site healed well, muscle strength of quadriceps and motion of knee were normal. Three cases were excellent,nine cases were well and 3 cases were good, according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 80 percent.ConclusionMultiple soft tissue defects of hand can be repaired by muliplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages included reduction of operation time and treatment, good recovery of hand contour and function. It is a good method to repair multiple soft tissue defects of hand.

Objective To analyze the protective role of intraoperative EMG monitoring in surgical removal of tumors related to the floor of the fourth ventricle and its influencing factors.Methods Intraoperative EMG monitoring was performed during the surgical removal of 32 patients with brain tumor, admitted to our hospital from January 2007 to December 2010; among these 32patients, 11 was conformed as having medulloblastoma, 9 ependymoma, 6 brain stem cavernous hemangioma, 4 brain stem exogenous glioma and 2 hemangioblastoma of the dorsal brain stem. The influencing factors of intraoperative EMG monitoring and the possible damage of cranial nerve nuclei caused by these surgical procedures were analyzed.Results Twenty-one patients enjoyed total removal, 9 sub-total removal and 2 partial removal. Good function protection of patient's posterior cranial nerves was noted in 9 patients, mild impairment in 18 patients, and moderate dysfunction in 5 patients.The influencing factors of EMG monitoring included leaking electric current caused by bipolar coagulation, excessive use of muscle relaxant drugs, changes in depth of anesthesia, and rapid changes of patient′s temperature, saline temperature and blood pressure. Conclusion The intraoperative EMG monitoring can provide evidence about the location of the cranial motor nuclei during the surgical removal of the tumor related to the floor of the fourth ventricle and the function protection of patient’s posterior cranial nerves.

Objective The aim of this study was to demonstrate the immunogenicity and safety of diphtheria, tetanus, pertussis (acellular, component) , poliomyelitis (inactivated) vaccine (adsorbed) and Haemophilus influenzae type b conjugate vaccine (DTaP-IPV//PRP-T) combined vaccine compared with commercially available DTaP (diphtheria, tetanus and pertussis), Haemophilus influenzae type b (Hib), tetanus conjugate and IPV monovalent vaccine. Methods Subjects were randomly divided into three groups, Group A and Group B were DTaP-IPV//PRP-T combined vaccine (PENTAXIMTM) vaccinated at 2,3,4 months of age or 3,4, 5 months of age respectively; Group C was commercially available DTaP. Hib tetanus conjugate (Act-HIBTM) and IPV (IMOVAX PolioTM) vaccines vaccinated at 3,4, 5 months of age. All groups received booster dose at 18 to 20 months of age, with antibody titers tested. Non-inferiority analysis was demonstrated in terms of seroprotection / seroconversion rates between Group A, Group B respectively and Group C. Safety information was collected after each vaccination to assess the safety of investigational vaccines. Results The non-inferiority of DTaP-IPV//PRP-T combined vaccine vaccinated at 2,3,4 or 3,4, 5 months of age versus DTaP, Hib tetanus conjugate and IPV vaccine was demonstrated for all vaccine antigens in both primary and booster phases in terms of seroprotection/seroconversion rates. DTaP-IPV//PRP-T combined vaccine was well tolerated. The rate of solicited/unsoliciated severe adverse reactions was very low and similar to the control vaccines. Conclusion DTaP-IPV//PRP-T combined vaccine was highly immunogenic with good safety profile in Chinese infants, which was comparable to the commercially available control vaccines.

Introduction: Assessment of root canal treatment (RCT) quality performed by undergraduate students is important in evaluating the teaching of endodontic. Hence, this study aims to evaluate the obturation quality of root canal treated teeth and the number of visits required by patients to complete RCT rendered by undergraduate students in School of Dental Sciences, Universiti Sains Malaysia (USM). Methods: All RCT cases performed by fourth year and final year undergraduate dental students in 2017/2018 were included in this study with a total of 258 teeth. Both digital and conventional periapical radiographs of all treated teeth were assessed. Evaluation of the obturation quality was classified as acceptable and unacceptable based on the length in relation to the radiographic apex and density of the obturation in relation to the presence of voids. The number of visits required to complete each RCT case by the students were also assessed. Results: Out of the total 258 teeth, 63.6% were maxillary and 36.4% were mandibular comprising 53.5% anteriors, 14.7% premolars and 31.8% molars. Overall acceptable obturation quality was 71.3%. There was significant association between obturation quality and type of teeth as well as location of teeth. Conclusion: Students in this institution performed significantly better obturation quality on anterior teeth than on premolars and molars as well as on maxillary teeth as compared to the mandibular teeth. Patients seemed to require more visits for RCT of molars than anteriors and premolars.