Objective To analyze the causes and outcome of conversion from tacrolimus (FK506) to cyclosporine-A (CsA) in recipients after liver transplantation.Methods 317 consecutive liver transplantation recipients in our department received anti-CD25 monoclonal antibody,FK506, mycophenolate mofetil and corticoid for prophylaxis of cellular rejection.The blood FK506 trough level was (10-15)?g/L within the first 30 days,(8-12)?g/L within next 60 days,and (5-8)?g/L was kept during 90 to 180 days after transplantation.All recipients reveived a follow-up of 6 months. Remits Sixteen out of 317 recipients (5.05%) required conversion from FK506 to CsA.The clinical indications for conversion included:neurological adverse effect of FK506 in 5 cases (31.25%),hema- tological adverse effect in 2 cases (12.5%),gastrointestinal effect in one case (6.25%),not capable of reaching therapeutic window concentration in 3 cases (18.75%),refractory hyperglycemia in 2 ca- ses (12.5%),and economic factor in 3 cases (18.75%).The majority of recipients demonstrated clinical improvement after the switch,except 2 of 16 patients (12.5%) had to be reconverted to FK506 due to renal disadvantage.No dead recipient and adverse effect correlated to immunosuppres- sive agent conversion were seen.Conclusion If necessary,conversion from FK506 to CsA in patients undergoing liver transplantation is safe and effective.

Objective: To construct a competency evaluation model for health managers based on the grounded theory, so as to provide insights into the training and evaluation of health managers. Methods: From December 2022 to March 2023, health managers with three years and more of working from health management center of a tertiary hospital, a health management enterprise and a university with a top-tier ranking for the major of "Health Services and Management" were invited, and a semi-structured interview on competency was conducted based on grounded theory. Coding techniques were applied to analyze the interview data, including open coding, axial coding, selective coding and theoretical saturation testing using NVivo12 software. Based on the coding results and drawing inspiration from McClelland's "Iceberg Competency Model Structure", a competency evaluation model for health managers was formulated. Results: Twenty-one health managers participated in the study, including 8 participants from the hospital, 7 participants from the enterprise and 6 participants from the university, 14 females, 17 participants with 3-10 years of working, and 6 participants with the rank of associate senior professional title or above. The interview yielded 5 main categories, from which the competency evaluation model for health managers was developed with five dimensions: professional development, health management capability, communication and coordination, humanistic care, and personal traits. professional development and health management capability constituted the overt competencies of health managers, while communication and coordination, humanistic care, and personal traits formed their implicit competencies. Conclusions The competency evaluation model for health managers constructed in this study includes explicit competency and implicit competency, which is expected to serve as a reference for the effective selection and cultivation of health managers.

Objective To study the correlation of multi-slice CT portography (MSCTP) and digestive endoscopy in the diagnosis and evaluation of esophageal and gastric varices (EGV) caused by cirrhosis.Methods A total of 92 patients with cirrhosis were enrolled in the prospective study.All the patients were examined by endoscopy and 64-slice spiral CT scan in 4 weeks.The types,grading of EGV were observed by endoscopy and MSCTP,and Kappa conformance test was applied with the endoscopic findings as gold standard.The sensitivity,specificity,consistency,and Youden index were evaluated for the diagnosis of sophageal and gastric varices by MSCTP.Results Sixty-five patients were diagnosed to have EGV by endoscopy and 27 were negative.The positive patients included 45 patients of GOV1,19 of GOV2 and 1 patient of IGV1.MSCTP diagnosed 67 cases of EGV and 25 patients of negative results.The positive patients included 46 of GOV1,18 of GOV2 and 3 of IGV1.Two patients of IGV1 varicose veins without positive findings on endoscopy were diagnosed by using MDCTP,which revealed isolated varicose veins under the gastric mucosa.There was high consistency between MSCTP and EGV in the diagnosis of EGV (Kappa =0.732,P ＜ 0.01).The sensitivity of MSCTP was 93.8％,specificity was 77.8％,consistency was 89.1％,and Youden index 71.6％.There was high consistency between MSCTP and EGV in the classification of EGV (Kappa values were 0.743 and 0.763,P ＜ 0.01).Conclusions There is high consistency between MSCTP and digestive endoscopic in the diagnosis and classification of EGV in cirrhosis.MSCTP is superior to endoscopy in the detection of gastric varices.

Using 16S rDNA clone library method, the bacteria composition of the Organic Matter-decomposing Inoculants A and B were investigated. The results indicated that: Sample A was clustered into 14 taxonomic operational units (OTUs),the dominant communities are Weissella confuse, Bacillus subtilis and Bacillus pumilus, which accounted for 28.6%,30.4% and 23.2%;Sample B was clustered into 43 OTUs,the dominant communities are Lactobacillus buchneri, Lactobacillus farciminis and Lactobacillus acetotolerans, which accounted for 18.03%,18.86% and 13.12%, respectively. The results had much difference from the samples' labels:there were not bacteria in the lable of sample A and only Bacillus pumilus was the same with the lable of sample B.This study showed that 16S rDNA clone library method has nicer application perspectives in analying the bacteria of microbial inoculant and its quality control.

Objective To explore the causes of postoperative recurrence in patients of nodular goiter,the selection of method for reoperation and the postoperative complications. Methods The clinical data of 278 nodular goiter patients admitted in the first affiliated hospital of Harbin Medical University between 2001 and 2008 were analyzed retrospectively,including the methods and complications for first operation and reoperation. Results In the first operation,79 eases received simple eminectomy and 167 cases received partial lobectomy,accounted for 28.4% and 60.1%,respectively. Unilateral subtotal lobectomy plus contralateral eminectomy was performed in 23 cases and subtotal thyroideetomy was conducted in 9 cases,accounted for 8.3% and 3.2%,respectively. Postoperative complications occurred in one hundred and twenty-three cases,the incidence being 8.2% (23/278). Unilateral subtotal Iobectomy plus contralateral partial iobectomy was reperformed in 37 cases and bilateral subtotal thyroidectomy in 241 cases. Postoperative complications occurred in 12 cases,the incidence being 4.2%(12/278). No postoperative recurrence of nodular goiter was found. Conclusions Recurrence of nodular goiter is closely associated with the scope of previous surgical treatment,and correct operative manipulation may reduce the recurrent rate.

In this paper, the concepts of surrogate outcomes and intermediary outcomes, their correlation with the primary outcome, how to select surrogate outcomes and intermediary outcomes and the particular requirements for using surrogate outcomes in assessing TCM clinical efficacy were discussed and described. It is difficult to evaluate clinical efficacy objectively and thoroughly by means of a single surrogate outcome for reason of the global characteristics of TCM, therefore, to rationally select such intermediary outcomes as important clinical symptoms, combination of several syndromes, patients' subject feeling, patients' satisfaction for treatment and quality of life, should be beneficial for objectively evaluating the efficacy of TCM intervention approaches.
Drugs, Chinese Herbal ; therapeutic use ; Health Status Indicators ; Humans ; Medicine, Chinese Traditional ; Outcome Assessment (Health Care) ; methods ; Phytotherapy ; Treatment Outcome

Aim To research the synergistic effect of hyperlipoproteinemia and Aβ in the processing of Alzheimer′s disease.Methods Seventy SD rats were randomly divided into seven groups, and dealt with D-gal(hypodermic injection), hyperlipemia diet, microinjection into both side of CA1 section in hippocampus, independently.Morris water maze(MWM) test was used to evaluate the spatial memory impairments.Tau and tau(pThr181) pathology in the hippocampus were detected using Western blot and immunohistochemistry.Nissl′s staining was used to detect cell apoptosis.Results Aβ25-35-treated rats showed significant impairments of spatial memory in MWM test, especially in the group of D-gal+Aβ25-35+HLD(P<0.01).Furthermore, these rats treated with Aβ25-35, D-gal, and hyperlipemia diet, exhibited significantly increased phosphorylation of tau, particularly in the Thr181 site.Conclusion Hyperlipoproteinemia is the risk factor for older person, which could strengthen the toxic effect of Aβ, and promote phosphorylation of tau.

Objective To study mechanical and cyclic fatigue behavior of IPS Empress2 under cyclic loading, and to establish guidelines for the use and design of all-ceramic crowns. Methods A 3-D finit element method model of tooth and crown were established. The strength and lifetime of all-ceramic crowns under cyclic loading in centric occlusion were investigated using computational techniques of the Abaqus and MSC Fatigue software. Results Most of the fatigue and fracture of all-ceramic crown occurred within the veneering material at cervical marginal of the crown. The number of loading cycles before failure occurred varied within specified limits 2 506 109-6 950 243. The lifetime of the crown decreased significantly as loading increased and decreased gradually as loading time increased as well. Conclusions The mechanical and fatigue behavior of ceramic materials and restorations need to be improved before clinical use in order to guarantee clinical long-term success of all-ceramic crown. The occlusal force should be adjusted properly in order to increase the longevity of all-ceramic crowns.

Global Health ; History, 20th Century ; Humans ; Influenza A Virus, H2N2 Subtype ; genetics ; isolation & purification ; Influenza A Virus, H3N2 Subtype ; genetics ; isolation & purification ; Influenza, Human ; epidemiology ; history ; mortality ; virology

Objective To explore the expression and the changes of ski with time in the injured spinal cord in rats. Methods Sixty adult female Sprague-Dawley rats were randomly divided into sham group (n=30) and injury group (n=30), each group were further divided into 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks subgroups, with 6 rats in each subgroup. Spinal cord injury at T10 was established with modi-fied Allen's technique (10 g × 25 mm) in the injury group. The hindlimbs behavior of rats was rated with Basso-Beattie-Bresnahan (BBB) scores 1 day, 3 days, 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks after spinal cord injury. Three rats in each subgroup were stained with HE staining to observe the pathological changes of the spinal cord and the formation of cavity. The other 3 rats were analyzed with im-munofluorescence staining of ski and semi quantitative analysis. Results The BBB scores of each time point were less in the injury group than in the sham group (P<0.05). Necrosis was the major pathological change in the injury groups 1 and 2 weeks after injury;cystic cavity completely formed 4 weeks after injury, with dense scar tissue around it;there was no significant change in the cavity and scar 8 and 12 weeks after injury, however, the adjacent spinal cord was obviously thinner. Ski expressed little in the normal spinal cord, and expressed more and more after injury, peaked at 8 weeks and decreased then. Ski was mainly observed in white matter in the sham group and 12 weeks injury subgroup, which was in gray matter 2, 4 and 8 weeks after injury. Ski was highly expressed around the cavity in injury center and formed high expression band. Conclusion Ski expresses after spinal cord injury in rats, that may be associated with the activation and prolif-eration of astrocytes and the formation of glial scar.