OBJECTIVE:To study the effect of irbesartan and losartan on pharmacokinetics of cyclosporin A(CsA)in rabbits. METHODS: 12 rabbits were randomly divided into two groups(n=6). In self-controlled study,plasma concentration of CsA in rabbits of two groups before and after treating with combination of irbesartan and losartan were determined and pharmacokinetics parameters were examined. RESULTS: After combination of irbesartan or losartan,the Cmax and AUC0～24 of CsA were significantly increased(P

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Objective To explore the clinical characteristics and prevention management of death events caused by infections in end-stage renal disease (ESRD)patients undergoing hemodialysis. Methods Clinical data of ESRD patients undergoing hemodialysis in Nephrology Department of Zhongshan Hospital from 1998 to 2008 were retrospectively studied.Death causes,primary diseases,complications,infections,and survival time were analyzed. Results A total of 252 patients died including 162 males(64.29%)and 90 females(35.71%).Average death age was (63.48±14.77)years.In death events,emergency dialysis accounted for 59.52%,and primary glomerular disease was the major primary diseases(27.23%),then diabetic nephropathy(16.90%)and hypertensive nephrosclerosis (14.55%).34.8%death was caused by infections or promoted by infections,secondly by cerebrovascular events(23.6%).The elderly accounted for the majority of infection-associated deaths.48.15%and 38.71%patients with deaths caused or promoted by infections respectively had shorter dialysis duration(<3 months),whose percentage was much higher than those with non-infection-associated deaths (30.34%).Primary infection was still pulmonary infection(77.59%),then blood infection(10.34%)and catheter-associated infection(5.17%).58.62%infection-associated deaths had positive microbiologic test results,and gram negative bacillus accounted for 38.24%.50% of patients with positive test was complicated with fungal infection. Conclusions Infection is a main cause and a critical promotion to death in ESRD hemodialysis patients,besides it is the main cause of death in the elderly (>75 years)and hemodialysis duration within 3 months,which may result in shorter survival.Pulmonary infection and gram negative bacillus combined with fungal infection should be considered in the treatment.Prophylaxis of nosocomial infection and pulmonary infection in hemodialysis patients should be more emphasized.

Objective:To investigate the clinical effect of the first dorsal metatarsal-dorsal phalangeal artery flap in repairing large area of soft tissue defect on the palmar side of finger.Methods:From February, 2016 to June, 2018, 11 fingers of 11 patients (7 males and 4 females, aged 19-46 years old with an average of 32.5 years old) with large area of soft tissue defect on the palmar side of the finger were repaired with the first dorsal metatarsal-dorsal phalangeal artery flap. These included 3 with the first dorsal metatarsal-first dorsal phalangeal artery blood supply, and 8 with the first dorsal metatarsal-second dorsal phalangeal artery blood supply. In which 3 with retained finger pulp was for repairing the defects and bridging arteries, including 1 flexor tendon defect repaired by the extensor digitorum brevis tendon of the second toe with the flap. The type of blood vessel was Gilbert I detected by CDU before surgery. The area of the flaps was from 1.5 cm×5.0 cm to 3.0 cm×8.0 cm. The donor area of the flaps was compressed with full thickness skin grafts of the shank. The follow-up data was collected by outpatient clinic visits and telephone interviews.Results:All the 11 flaps survived and were followed-up for an average of 14 months, ranged from 6 months to 24 months. The colour and texture of the flaps were good. Sensing of temperature, pain and touch restored, without swelling. Function of the fingers was well restored. The range of motion of distal and proximal interphalangeal joints was closed to normal. The TPD of the flaps was 5-11 mm, with an average of 8 mm. Ten had primary wound healing in the donor sites of foot. One case had necrosis of the proximal toe of the skin graft and healed after dressing change. Long-term follow-up of the skin grafting area was wear-resistant, and does not hinder walking without rupture.Conclusion:Application of the first dorsal metatarsal-dorsal toe artery flap to repair large area of soft tissue defect on the palmar side of finger has number of advantages such as it, covers the wound and carry the tendons, bridges the arteries at the same time, plus delivers satisfactory outcome.

Objective To establish and verify the personalized reference interval of blood cells.Methods The results of blood cells from 2 089 health subjects in 2014,2015 and 2016 were collected.The ratio of the later results to the previous results was defined as the fluctuation (λ).The ratio (λ1) of the results of 2015 to the results of 2014 was calculated and λ1 was analyzed statistically to establish the fluctuation reference interval (CIλ).The ratio (λ2) of the results of 2016 to the results of 2015 was calculated.λ2 was used to verify λ2.The personalized reference interval (CIp) was established by multiplying each result of 2015 and CIλ.CIp was verified by results of 2016.The ratio of the upper and lower limits of CIp was calculated.The ratio of the upper and lower limits of the reference interval (WS/T 405) was calculated.Results The values of CIλ were as follows:WBC (0.66 to 1.53),L(0.67 to 1.51),M (0.50 to 2.00),N(0.56 to 1.78),E(0.4 to 2.51),PLT(0.76 to 1.32),RBC(0.92 to 1.12),Hb(0.92 to 1.11),Hct(0.91 to 1.12),MCV(0.95 to 1.07),MCH(0.95 to 1.05)and MCHC(0.94 to 1.06).The validation tests of CIλ and CIp showed that both CIλ and CIp were suitable for this laboratory.Compared with the reference interval of professional criteria,the ratio of the upper and lower limits of the CIp was smaller than that of traditional criteria.Conclusion CIp for this laboratory was established and verified.Compared with traditional criteria,CIp should be more personalized and highly sensitive.

This study was aimed to observe the effects of acupuncture combination with medicated thread moxibustion ofZhuang nationality medicine on neurotransmitters in rats with sleep deprivation. A total of 80 SPF grade healthy Wistar rats were randomly divided into the control group, model group, treatment group and diazepam group with 20 rats in each group. The establishment of insomnia model was through sleep deprivation in the model group, treatment group and diazepam group. Based on the treatment of the model group, the treatment group was treated by acupuncture combination with medicated thread moxibustion ofZhuang nationality medicine, once a day for continuous 14 days. Intragastric administration of diazepam according to 3 mg·kg-1 body weight was given in the diazepam group. While intragastric administration of the same volume normal saline was given to the control group once a day for continuous 14 days. And then, the levels of orexin, NE, 5-HT, CRH and ACTH were detected. The expressions of orexin mRNA and c-Fos were observed. The results showed that compared with the control group, the levels of orexin, ACTH, 5-HT, NE and CRH increased or obviously increased in the model group with significant difference (P < 0.05, orP< 0.01). The expressions of orexin mRNA and c-Fos in the model group were increased or obviously increased with significant difference (P < 0.05, orP< 0.01). Compared with the model group, the levels of orexin, ACTH, 5-HT, NE and CRH reduced or obviously reduced with significant difference in the treatment group (P < 0.05, orP < 0.01). The expressions of orexin mRNA and c-Fos were reduced or obviously reduced with significant difference in the treatment group (P <0.05, orP < 0.01). It was concluded that acupuncture combination with medicated thread moxibustion ofZhuang nationality medicine took an effect on the treatment of insomnia by mediating neurotransmitters associated with hypothalamic-pituitary-adrenal axis (HPA axis) through orexin, which was probably related with its therapeutic mechanism.

Objective To analyze the outcome of total knee arthroplasty with retaining patellar in osteoarthritis.Methods 45 knee joints in osteoarthritis were performed operatively with posterior stabilized knee arthroplasty between January 2005 and June 2008. The series include 7 sides(males) and 38 sides(females). The mean age of patients was 65.7 years ranging from 52 to 79 years, and the data were analyzed by The Hospital for Special Surgery(HSS) score system. Results The follow-up period was averagely 25 months ranging from 8 to 51 months. According to HSS score system, 28 sides were rated as excellent（62.2%）, 12 sides as good（26.7%）, 4 fair（8.9%）and 1 poor（2.2%）, and the excellent-good rate was 88.9%. Conclusion Posterior stabilized knee arthroplasty with retaining patellar represents a simple and valuable treatment methodology for the most osteoarthritis of the knee joint.

Objective To explore the application and clinical effect of blood bridge venous flap in finger wound with proper palmar digital artery defect. Methods From February,2007 to September,2016,11 cases of fin-ger wound with artery defect were repaired with forearm vein free flap by the way of bridging blood vessels. The time from injury to surgery was 1.5 to 6 hours(average 2.5 hours).Vascular defect length was 1.4 to 3.4 cm(average 2.3 cm). 8 cases were bridged the unilateral digital artery and 3 cases were bridged the both side. The area of skin flap was 1.5 cm × 2.0 cm to 2.2 cm × 3.5 cm and the donor site was sutured directly. Results One case appeared necrosis in marginal part and healed after dressing change. The other flaps and finger survived and the incisions healed well.All the 11 cases were followed up after operation. The follow-up time ranged from 6 to 20 months, aver-aged 10 months. The color and texture were well,the sensation of temperature, pain and tactile were recovered, and the flap had good contour. According to TAM system evaluation method: 6 cases got excellent results,4 cases were good,1 case was poor. The donor site only had a linear scar and the flexion and extension of wrist were not limited. Conclusion Flow bridging venous flap can reconstruct the finger blood and repair the wound simultaneously. To the finger with nerve or tendon defect,bridged with the cutaneous nerve or palmaris longus tendon can also get satisfactory result.

OBJECTIVE: To explore the predictive value of overall longitudinal strain for the development of cardiomyopathy without hypertrophic changes. METHODS: Sixty five patients with suspected hypertrophic cardiomyopathy (HCM) but without hypertrophic changes were selected. Genetic variant, overall longitudinal strain, left ventricular ejection fraction, end diastolic volume, end systolic volume, interventricular septal thickness, left ventricular diameter and end diastolic diameter were detected. The risk factors of HCM were analyzed. RESULTS: Forty four variants of 16 genes were identified, among which MYBPC3 13659G>A was the commonest (73.20%) and MYH7 13252C>T was the second (31.25%). MYBPC3 GG genotype, overall longitudinal strain and apical longitudinal strain were correlated with HCM (P<0.05). CONCLUSION The increase of longitudinal strain is of great value in predicting the occurrence of HCM.

Objective: To explore the application and effect of using the lateral second toe flap transfer for reconstruction of great toe defect. Methods: The flap on tibial of second toe was designed according to the size of defect. The pedicle of the flap is the tibial proper plantar digital artery of the toe, and the rotation point is located between the toe web.13 cases of the great toe′s defects were repaired by this method, with the donor sites covered by full thickness skin from the leg. Results: 13 flaps survived postoperatively. All cases were subject to postoperative follow-up, follow-up time was 6-48 months, an average of 18 months. Skin color and texture was close to that of the surrounding tissues, appearance is not bloated. Conclusions The second toe lateral skin flap is easy to operate, is flexible for rotating. As local material, it is an ideal skin flap to repair the great toe defect.