The directed molecular evolution of enzyme in vitro can not only improve the efficiency of evolution, but also evolve enzyme according to the investigator's desire. This review summed up the feasible methods of this novel technique.

Objective To discuss the advance and experience of postoperative management in multivisceral transplantation(MVT).Methods Five patients with abdominal multiple organs malig- nances were subjected to multivisceral transplantation.The excised specimens included the liver,pan- creas,duodenum,stomach,spleen,mesentery and all of the involved lymph nodes.The transplanted organs were liver,pancreas,duodenum and parts of intestine.Patients were monitored and sustained stably in breath,hemodynamics and homoeostasis.The coagulation was also monitored and kept in balance.The intensive immunosuppressive protocol,including steroid,tacrolimus,mycophenolate mofetil and Zenapax,was used to prevent the acute rejection.The endocrine and exocrine of pancreas were tested,color Doppler examination was done every day,and Somatostatin was used to prevent pancreatitis.Drugs to bacteria,fungus and virus infection were prophylactically used.Results All patients waked up with 4-6 h after operation and began recovering with 3-7 days.Dynamic examina- tions revealed that the functions of grafted liver,pancreas and duodenum were satisfactory.No com- plications of acute rejection,pancreatitis,bleeding and thrombosis occurred.Conclusion Many ques- tions in postoperative management related to multivisceral transplantation are devoted to study.Nice experience of management to organ transplantation,detailed monitoring and prophylactically medica- tions are safeguards to steady recovering and further prognosis.

Objective: To further understand the role of folic acid supplements rivaling MTHFR gene silencing in pathogenesis of NCLP, RNA interference (RNAi) was applied to knock down MTHFR in mouse embryonic palatal mesenchymal (EPM) cells. Methods: MTHFR ShRNA expression vector were transfected into the primary cultured EPM cells. MTT was used to observe cell proliferation after MTHFR gene silencing. FCM was used to observe cell cycle after MTHFR gene silencing. Results: The results showed the cells proliferation had an inequality amelioration after using folic acid supplements in MEPM cells with MTHFR gene silencing. Using folic acid supplements rivaled the effect of MTHFR gene silencing had a dose-dependent manner. Using 20 μg/ml folic acid supplements could improve the cell proliferation to achieve normal level of cell proliferation. Conclusion: MTHFR gene is an important candidate gene of NCL/P. Using folic acid supplements could prevent teratogenic MTHFR gene silencing for embryonic palate development.

This paper expounds the concept and connotation of the nurse professionalism, introduces the re-search status of foreign nurses professionalism assessment tools,discusses the influence factors of nurse professional-ism,including:personal factors, organizational factors and occupational factors.It also puts forward following sugges-tions:constructing the nurse professionalism of theoretical system and evaluation methods, advocating the spirit of nurses professionalism cultivation,creating a health care professional environment,providing the reference the devel-opment of our country's theory and improve the nurse professionalism.

Objective To explore the clinical characteristics and management of acute myocardial infarction (AMI) early after kidney transplantation (＜3 months).Method Five cases of AMI early posttransplantation among 122 kidney transplant recipients from June 2011 to December 2012 were retrospectively reviewed.Results Of 5 AMI patients,there were 2 cases within one week postoperatively,one case at 11 th day postoperation,and the other two at 29th day and 46th day after operation respectively.Acute left heart failure was complicated in 3 cases within first two weeks.All the AMI patients had elevated TnⅠ levels which declined subsequently.The climax of TnⅠ levels in all the 5 AMI patients were above 5 ng/mL,and more than 20 ng/mL in two AMI patients within one week.Given by symptomatic and supportive treatment,antiplatelet and anticoagulation therapies and cardioprotective medications,all the five AMI patients were improved.Low molecular heparin was additionally administrated to the 2 cases within first week according to the severe conditions.New emerged small volume of hematocele was proved by ultrasound after 3 days and low molecular heparin was ceased.All the 5 patients survived and neither thrombolysis nor percutaneous coronary intervention therapy was given to them.Conclusion In addition to general prevention against AMI in kidney recipients with high risk factors,managing anemia and hypertensiorn,and improving graft function and systematic status are also important to decrease the risk of AMI.Moreover,cardioprotective therapy including antiplatelet therapies,beta-blockers,angiotensin-converting enzyme inhibitors (ACEI)/angiotensin-2 receptor blockers and statins,which are recommended to the general population with AMI,will also profit to the kidney transplant recipients with AMI.However,aggressive intervention therapies might be more prudent to be used in this population.

Environmental Pollution ; prevention & control ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Iatrogenic Disease ; prevention & control ; Medical Laboratory Personnel ; psychology

Objective To optimize the cerebral ischemia-reperfusion process for acute ischemic stroke patients,so as to reduce the time of in-hospital delays.Methods A multi-disciplinary management team was established to design the flowchart of the cerebral ischemia-reperfusion process for acute ischemic stroke patients.By applying Healthcare Failure Mode and Effect(HFMEA) management mode,intervention was conducted and its effect was analyzed.Results After implementation of the HFMEA intervention,the door to needle time(DNT)was reduced from 88 (42,140) minutes to 45 (37,59) minutes(P＜0.001);the ratio of patients with the DNT＜60 minutes increased from 20％ to 87.7％(P＜0.001);the door to cerebral ischemia-reperfusion time was shortened from 207(169,227) minutes to 165(155,185) minutes (P＜O.05).There was no significant difference in the incidence and mortality of symptomatic cerebral hemorrhage between before and after intervention (P＞0.05).Conclusion Utilization of HFMEA to optimize the emergency cerebral ischemia-reperfusion process can effectively reduce the in-hospital delays of acute ischemic stroke patients.

Objective To investigate the clinical value of a new anvil inserting method for esophagogastrostomy or esophagojejunostomy during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer.Methods The clinical data of 21 patients with gastric cancer who received laparoscopic radical proximal gastrectomy or radical total gastrectomy at the Southwest Hospital from March 2010 to February 2011 were retrospectively analyzed.Five trocars were inserted through the abdominal wall of the patients.After perigastric lymphadenectomy and mobilization of esophagus,an incision was made on the esophagus above the tumor,and then the anvil with drawn wire attached was inserted into the esophagus.An endo-cutter was applied to cut the esophagus adjacent to the incision left the drawn wire untouched,and then the stem of the anvil was pulled out by the drawn wire for laparoscopic anastomosis. Results The operations were successfully accomplished under the laparoscope with no conversion to open surgery.Fifteen patients received laparoscopic radical total gastrectomy and 6 received laparoscopic radical proximal gastrectomy. The mean operation time,volume of blood loss,time to off-bed activity,passage of flatus and postoperative duration of hospital stay were (257 ± 38) minutes,( 119 ± 32) ml,(2.5 ± 0.5 ) days,( 3.7 ± 0.8 ) days and (7.5 ± 2.6) days,respectively.No perioperative mortality,anastomotic bleeding or anastomotic fistula was detected.One patient was complicated with pulmonary infection + pleural effusion and was cured by conservative treatment; 1 was complicated with anastomotic stenosis which was alleviated by gastroscopic balloon dilation; 1 was complicated by incisional infection and was cured by medical treatment after drainage.No cancer cells were detected at the anastomotic ring or resection margin of the specimen.There were 4 patients with well-differentiated adenoma,8 with moderate-differentiated adenoma and 9 with poor-differentiated mucinous adenoma.There were 5 patients in stage Ⅰ,10 in stage Ⅱ and 6 in stage Ⅲ (UICC staging).Twenty-one patients were followed up for a mean period of (11 ±4) months (range,6-17 months ),no tumor recurrence or metastasis was detected. Conclusions The new technique for anvil insertion is safe,effective and easy for manipulation and learn.It offers a new approach for laparoscopic digestive tract reconstruction.

Abdominal Pain/etiology* ; Acute Disease ; Appendicitis/diagnosis* ; Diabetes Mellitus ; Diabetic Ketoacidosis/diagnosis* ; Diagnostic Errors/adverse effects* ; Humans ; Insulin

Objective To investigate the effects of CO_2 pneumoperitoneum on the expression of focal adhesion kinase (FAK) of gastric cancer MKN-45 cells. Methods CO_2 pneumoperitoneum with different pressures was simulated in vitro, and the gastric cancer MKN-45 cells were divided into test and control groups. In the test group, gastric cancer MKN-45 cells were cultured in CO_2 pneumoperitoneum with different pressures [5, 10 or 15 mm Hg (1 mm Hg =0.133 kPa)] for 4 hours. The condition of the cells exposed to CO_2 pneumoperitoneum with a pressure of 15 mm Hg was observed at 0.5, 2 and 4 hours. Gastric cancer MKN-45 cells in control group were cultured at normal atmospheric pressure. The expression of FAK and phosphorylated FAK (FAK Tyr397) of each group was detected by Western blot. Multiple-group analysis was done by one-way ANOVA, and intergroup comparison was done by LSD test. Results In CO_2 pneumoperitoneum with pressures of 5, 10, 15 mm Hg, the expression of FAK was 2.14±0.17, 2.07±0.21 and 2.52±0.26, respectively, and the expression of FAK Tyr397 was 1.82±0.28, 1.93±0.52 and 3.71±0.37, respectively. The expression of FAK and FAK Tyr397 in the control group was 2.43±0.46 and 1.71±0.23, respectively. We found significant differences between the 2 groups (F = 2.171, 26.951, P < 0.01). After gastric cancer MKN-45 cells being treated for 0.5, 2 and 4 hours in CO_2 pneumoperitoneum with a pressure of 15 mm Hg, the expression of FAK Tyr397 was 3.41±0.44, 4.12±0.56 and 5.24±0.41 respectively, which is also significantly different (F =116.119, P < 0.01). The expression of FAK Tyr397 was back to 0.72±0.16 1 hour after the release of CO_2. Conclusions CO_2 pneumoperitoneum with different pressures can not promote the expression of FAK in gastric cancer MKN-45 cells which had been cultured for 4 hours, but can activate FAK through promoting its phosphorylation. The degree of FAK phosphorylation increases with pressure and time, and the activity of FAK decreases to pretreatment level rapidly once pressure is released.