OBJECTIVE:To observe the hypotensive effect of Urapidil in operation on patients with fundus oculi disease accompanying hypertension.METHODS:Urapidil was injected iv first and then dripped.The SP,DP and heart rate were ob?served at given times and ECG was monitored.RESULTS:The total effective rate was95.1%,average SP decreased43.97mmHg(P

Objective To investigate the changes and clinical signficance of nitric oxide(NO) and endothelin(ET) in children with lymphoma.Methods NO and ET of 39 cases with lymphoma and 33 normal controls were examined by using nitrose reductase method and RIA method.Results Compered to normal controls,NO and ET were higher in children with lymphoma;smilar to normal controls in complete remission(CR) and partial remission(PR);relapse cases were higher than remission.Conclusions NO and ET could have relation to lymphoma in children,testing the changes of NO and ET have signficanc to the assistant diagnosis,observeing effect and judging prognosis.

Objective To explore the role of neutrophil extracellular traps (NETs)-induced endothelial cell damage in the pathogenesis of dermatomyositis (DM)-associated interstitial lung disease (ILD).Methods Serum free DNA and krebs von den lungen-6 (KL-6) level were tested in healthy controls,dermatomyositis patients with or without interstitial lung disease (DM-ILD and DM-NILD).Subjects' peripheral blood neutrophils were stimulated with phorbol 12-myristate 13-acetate (PMA),then human umbilical vein endothelial cells (HUVECs) were co-cultured with NETs.The cell morphology was observed by the inverted phase contrast microscope.Cell viability was detected by cell counting kit-8 (CCK8).Results The concentration of serum free DNA in DM patients [(271.27 ± 76.53) μg/L] was significantly higher than that in health control (HC) [(152.89 ± 37.34) μg/L,P ＜ 0.001].Moreover,free DNA level in DM-ILD patients [(302.67 ± 74.15) μg/L] was higher than that in DM-NILD patients [(235.59 ±63.55) μg/L,P ＜0.005].The concentration of KL-6in DM patients [(3.08 ±2.07) μg/L] was higher than that in HC [(0.87 ± 0.51) μg/L,P ＜ 0.001].Similarly,KL-6 in DM-ILD patients [(4.00 ± 2.44) μg/L] was higher than that of DM-NILD patients [(2.03 ± 0.61) μg/L,P ＜ 0.005].Free DNA and KL-6 were positively correlated (r =0.251,P ＜ 0.05).The survival of endothelial cells in DM group (53 ± 11) ％ was lower than that of HC group [(70 ± 5) ％,P ＜ 0.001].Not surprisingly,the survival of endothelial cells in DM-ILD group (44 ±4) ％ was lower than that in DM-NILD group [(61 ± 8) ％,P ＜ 0.01].Conclusion NETs could play an important role in the pathogenesis of dermatomyositis associated interstitial lung disease,suggesting that NETs may be the potential therapeutic target.

Objective To investigate the efficacy,safety,economy evaluation of CYP3A5 * 3 gene polymorphism in providing individualized administration for the use of tacrolimus (Tac) in renal transplantation recipients.Method Pyrophosphate sequencing method was used to determine the CYP3A5 * 3 genotype of renal transplant patients in the first day after surgery.Computer-generated random numbers were used to assign 60 patients into experiment group or control group.Both groups of patients were routinely given the initial dose of Tac (4.0 mg/day) in the first day after surgery.The patients in the experiment group were given different doses of Tac based on the different CYP3A5 * 3 genotypes at the third day after surgery [for AA,AG:0.12 mg/(kg day),and for GG:0.06 mg/(kg day)].The patients in the control group were given different dosages of Tac according to drug concentration.The patients were followed up for 12 months,and different parameters were compared between two groups.A decision tree model was populated with data from the study and used to economics evaluation.Result At day 5 after the transplantation,significantly more patients in the experiment group were within the Tac target C0 range [90％ (27/30)] as compared to the control group [46.67％ (14/30) (P＜0.05).At this time point,the median Tac C0was 5.08 [(2.5-8.7) μg/ L] in the experiment group vs.5.29 [(1.3-13.6) μg/L] in the control group (P＜0.05).When C0/ D was analyzed according to CYP3A5 * 3 genotype,we found the mean C0/D in the both groups with CY3A5 * 3/* 3 ＞CYP3A5 * 3/* 1 ＞ CYP3A5 * 1/* 1.It was noted that the time to achieve target Tas was (4.40 ± 0.97) in the experiment group,vs.(7.57 ± 3.42) in the control group.In total,the number of daily dose modifications was 11 in the experiment group and 49 in the control group in two weeks after transplantation (P＜0.05).Renal function at day 14 after transplantation and adverse events during 12 months of follow-up were similar in both groups.In total,10 adverse events were reported in the experiment group and 11 in the control group (P＞0.05).The results of costeffectiveness analysis showed that the cumulative costs and effects in the experiment group were ￥ 38 067 and 0.90 quality-adjusted life years gained,and those in the control group were ￥38 681 and 0.87 quality-adjusted life years gained,respectively.In the base case analyses,experiment group was more cost-effective.Conclusion Individualized adjustment of Tac doses for patients according to recipients different CYP3A5 * 3 genotypes is beneficial for reaching target concentration as soon as possible and more cost-effective.But the demonstration of the clinical relevance of this approach was not achieved.Higher methodological quality,and larger sample size study are still needed.

Objective To analyze and compare the dosage,blood concentration and metabolic characteristics of Tacrolimus (Tac) for pediatric patients who underwent living related liver transplantation (LRLT) or donation after cardiac death liver transplantation (DDLT).Methods The clinical data of 75 liver transplantation pediatric patients from October 2012 to August 2015 were retrospectively analyzed.According to the different source of donors,the recipients were divided into two groups:LRLT group (40 cases) and DDLT group (35 cases).Results (1) Under the condition of same initial Tac dosage,the Tac dosage in LRLT group was less than in DDLT group during the first 28 days post-transplantation (P＞ 0.05).However,the Tac dosage in DDLT group was significantly higher than in LRLT group on the second and third months after sugery (P =0.000).(2) Correlation analysis revealed that graft-recipient body weight ratio (GRWR) was correlated with Tac dosage (mg·kg-1 ·d-1) on the 14th day postoperative (LRLT group:r=0.579,P＜0.05;DDLT group:r =0.583,P＜0.05) and Tac concentration/dosage ratio (LRLT group:r =-0.607,P＜0.05;DDLT group:r=-0.680,P＜0.05).Conclusion Tac has a satisfactory anti-rejection effect on liver transplantation pediatric patients while the metabolism varied with each individual.There is a positive correlation between the early Tac dosage and the GRWR in both groups.It is necessary to set individualized Tac administration regimen according to the metabolic characteristics and GRWR.

Objective To investigate the effects of simultaneous hepatic artery and portal revaseularization on the expression of TNF-α during bile duet ischemia-reperfusion injury in rats liver transplantation.Methods Male Spragne-Dawley rats were used to establish an autologous orthotopic liver transphmtation model.Model rats were random divided two groups,simultaneous revascularization group(sroup P)and portal vein revascularization group(group N).The animals were separately killed at the 2nd hour,6th hour and 24th hour after reperfusion.Plasma samples were collected for ALT,AST,GGT,AKP,TBiL and DBiL test.Bile duct tissues were collected to detect the histolosical changes,MPO activit,and the expression of TNF-α mRNA.Results The serum levels of GGT in group P was significantly lower than that in group N at the 6th hour and 24th hour after reperfusion(P＜0.05).And the serum levels of AKP,TBiL and DBiL and the morphological scores of bile duct in group P were significantly lower than that in group N at the 24th hour after reperfusion(P＜0.05).The activity of MPO in group N was significantly higher than that in group P at the 6th hour after reperfusion(P＜0.05).Compared with group N,the expression of TNF-αmBNA was reduced significantly in group P at the 2nd hour and 6th hour after reperfusion(P＜0.05).Conclusion Simultaneaus hepatic artery and portal revascularization can alleviate I/R induced bile duct injury of rat liver grafts,and the protective mechanism may be asseciated with inhibition the expression of TNF-α and decrease of neutrophil infiltration.

Objective To discuss the value of emergency bedside ultrasound in diagnose of blunt abdominal injury. Methods Portable ultrasound was used in 184 patients with blunt abdominal trauma in emergency department. The abnormal changes of the sound and image of the abdomen were observed,paying equal attention to free intraperitoneal fluid and gas. Results The emergency bedside ultrasound identified 169 (91.8%) patients with blunt abdominal injury, of whom 149 patients (95.5%) with single-organ injury and 20 patients (71.4%) with multi-organ injury. There were 21 patients missed diagnosis and three misdiagnosed, with rate of missed diagnosis and misdiagnosis of 13%. Surgical treatment was performed in 119 patients and conservative treatment in 65, which were proved by CT/MRI examination or clinic conservative treatment. Conclusion Emergency bedside ultrasound can provide fast and credible diagnostic information for blunt abdominal trauma, with high diagnosis accordance rate.

Prognosis and treatment of primary Sj?gren′s syndrome with renal tubular acidosis

Objectives: To investigate the significance of CT multi-planar reconstruction of vertebral artery CT angiography(CTA) in C2 pedicle screw placement. Methods: The vertebral artery CTA images of 77 pa-tients were reviewed retrospectively by CT multi-planar reconstruction. The positions in three dimensions were adjusted according to the screw′s ideal direction, and the cross section of the screw passing through the pedicle was displayed based on CT multi-planar reconstruction. A circle was demarcated on the former plane to simulate the cross section of the screw. The diameter of the circle, the accommodation of screw in C2 pedicle, and the positions of the screw related to the vertebral artery were taken into account to assess the feasibility of pedicle screw placement. And meanwhile, the feasibility was assessed by measuring the inner di-ameters of pedicle complex. The results of the two methods were compared. Results: The simulation of place-ment of C2 pedicle screw basing on CT multi-planar reconstruction illustrated the accommodation of screw in C2 and its relationship with surrounding structures. According to this method, 10(13%) cases of left side and 19 (25%) cases of right side could not accommodate the circle with the diameter of 4mm and could not be placed pedicle screw, while operation was unavailable for 12(16%) cases of left side and 20(26%) cases of right side by measurement of inner diameters. The P value of McNamara test was 0.5 in the left and 1 in the right. There was no significant differences between the results of two methods(P>0.05). The result of Kap-pa test was 0.770 in the left and 0.732 in the right, and the P value of the Kappa test in the both sides was 0, which showed good consistency. Conclusions: The simulation of placing pedicle screw in axis basing on CT multi-planar reconstruction can illustrate the screw accommodation in C2 and its relationship with sur-rounding structures, which can provide good reference for the operation.

Objective To study the clinical manifestation,treatment and prognosis of patients with primary Sjgren′s syndrome and renal tubular acidosis.Methods Sixty patients who were diagnosed as pSS complicated with RTA during the last 13 years were retrospectively analyzed and followed up for 7 5 years on average.Results Distal renal tubular acidosis ( n =53,83 3%) was much more frequeut than the proximal one ( n =7,11 7%).Hypokalemic paralysis,diabetes insipitus,and calcification of the renal tissue appeared in 49 patients (92 4%).Glomerular lesions were found in 12 of the 15 patients who underwent kidney biopsy.Renal insufficiency was developed subsequently in 4 out of 5 patients with glomerular sclerosis.Abnormal serum creatinine was detected in 11 patients (18 3%),and in 7 of them it persisted 11 5 years on average after the onset of RTA.Two of them died from renal failure and 1 received hemodialysis.Hypergammaglobulinemia was more obvious in the patients with renal insufficiency than those without ( P