membrane transporters are a cIass of functionaI membrane proteins and mediate the absorption,distribution and eIimination of many drugs. They are biomoIecuIes responsibIe for the homeo-stasis,and they,however,are easiIy reguIated by many kinds of chemicaIs. The IocaIizations,func-tions,substrates and seIective inhibitors of 18 more understanding transporters among the 26 known ones in the kidney are summarized in this review. The impact of these transporters on drug disposition and the typicaI drug-drug interactions concerned are aIso discussed.

Objective To compare the safety and feasibility of thoracoscopic extrapleural Nuss procedure with traditional intrapleural Nuss procedure. Methods Total 252 patients with pectus excavatum received Nuss surgery from July 2008 to June 2009 in Beijing children' s hospital. Patients had following condition were excluded; (1) recurrent pectus excavatum; (2) complicated with other diseases, and need simultaneous surgery; (3) older than 13-year-old; (4) extensive depression, and need two Nuss bar; or (5) extreme severe or severe unsymmetric. 131 cases were selected in our study and they were randomly divided into two groups, thoracoscopic extrapleural Nuss procedure ( n = 62 ) and traditional intrapleural Nuss procedure ( n =69). Perioperative information, postoperative complications, effectiveness and the location of the Nuss bar were compared between two groups. Results All the 131 patients had completed the procedure successfully. There were no significant differences in age, Haller index; surgical effects, operation time, blood loss, and hospital stay, between two groups. Postoperative complications between the two groups are not significant. 131 patients were followed up from 14 to 26 months, and no recurrence and long-term complications occurred. About more than half cases of extrapleural Nuss procedure group were break the pleural into thoracic cavity. Conclusion Both extrapleural and intrapleural Nuss procedure are safe and effective for pectus excavatum, but extrapleural Nuss procedure have no advantage to the intrapleural Nuss procedure, also it' s hard to observe the other side of thoracic cavity during the surgery, and not easy to grasp and to promote.

Objective To verify the safety of non-thoracoscopic Nuss procedure,and review our experience in correction of pectus excavatum by Nuss procedure with post-implantation thoracoscopic assistance.Methods 191 patients with pectus excavatum were surgically corrected by Nuss procedure with post-implantation thoracoscopic assistance.There were 146 boys and 45 girls,The age ranged from 2.8 to 20 years with mean age was ( 6.46 ± 3.36) years.Hailer' s index was 4.68 ± 1.84.The operation was performed under Non-thoracoscopic assistance first and then with thoracoscopic observation.Results The operation in all patients had been performed successfully.The time of the operation ranged from 27 to 50 minutes with mean time was ( 32.49 ± 2.79) minutes.The average bleeding volume during procedure was ( 2.19 ± 0.87 ) ml.The durstion of follow-up was 10 to 23 months.All patients have been satisfied with their surgical correction.The postoperative complication was 13 cases( 6.81％ ).The bar outsides the pleura in both sides was 18 cases( 9.42％ ).The bar outsides the right pleura was 23cases( 12.0％ ).The bar outsides the left pleura was 17 cases( 8.90％ ).Conclusion Nuss procedure with non-thoracoscopic assistance for correction of poctus excavatum is safety if the surgeon experienced and have certain methods.Post-implantation thoracoscopic Nuss procedure is safer,and can deal with the damage caused by non-thoracoscopic assistance.

Objective To summarize the experience of diagnosis and treatment of pectus excavatum associated with congenital pulmonary disease in children.Methods The data of 91 patients with pectus excavatum associated with congenital pulmonary disease was collected from July 2002 to August 2010 in Beijing Children's Hospital.There were 64 males and 27 females.30 patients with pectus excavatum associated with congenital pulmonary cyst,congenital cystic adenomatoid malformation,pulmonary sequestration,and some severe cases of congenital lobar emphysema received the Nuss surgery and lobectomy simultaneously.Results 30 cases with pectus excavatum asseeiated with congenital pulmonary disease received simultaneous Nuss procedure and lobectomy.All cases were confirmed by pathology and recovered uneventfully.Conclusion Chest CT scan is an effective way to evaluate pectus excavatum associated with pulmonary diseases.Whether surgery is needed for the pulmonary disease depend on the specific types of disease,age and other various factors.Simultaneous surgery for pectus excavatum and pulmonary disease can lower the risk of the multiple operations,and reduce the financial burden of famihes.

Objective To compare the clinical effects of different doses of methylprednisolone therapy for children with severe hand,foot and mouth disease (HFMD).Methods According to different dosage methods, 240 children with severe HFMD were divided into large dose group,medium dose group and small dose group,80 cases in each group.The three groups were given different doses of methylprednisolone infusion on the basis of conventional treatment:large dose group(5 ~10mg·kg· -1 d -1 ),medium dose group(3 ~5 mg·kg· -1 d -1 ),small dose group (1 ~2mg · kg · -1 d -1 ).Results The time of fever sustaining,panic ease,mechanical ventilation,duration of hypertension and heart rate recovery of the medium -dose group were (47.93 ±4.72)h,(45.54 ±2.42)h,(51.43 ± 6.85)h,(53.66 ±7.62)h,(52.45 ±7.84)h,which were significantly shorter than those of the small -dose and large -dose group(all P <0.05).The incidence of turning to critically ill and the rate of ventilator use of the medium-dose group were significantly lower than those of the small -dose and large -dose group (all P <0.05 ).The incidence of pulmonary edema and pulmonary hemorrhage of the medium -dose group were significantly lower than those of the small -dose and large -dose group(all P <0.05).The differences among three groups were not statistically significant in the complications such as hypokalemia,hypocalcemia and gastrointestinal bleeding (all P >0.05 ). Conclusion Medium dose of methylprednisolone in the treatment of children with severe HFMD has significant effect and less adverse reactions,which is worthy of promotion.

Objective To investigate the influence of obesity on renal lesion in IgA nephropathy (IgAN) patients by analyzing the association between obesity and absolute renal risk factors (ARR).Method Clinical-pathological data of IgAN patients diagnosed by renal biopsy in General Hospital of Ningxia Medical University were collected retrospectively.According to the body mass index (BMI),patients were divided into non-obese group (BMI ＜ 28,N-OB group) and obese group (BMI≥28,OB group).Their clinical characteristics,pathological index and ARR scores were compared.The relationship of BMI and ARR was analyzed by ordinal logistic regression models.Results (1) A total of 674 IgAN patients with mean age of 35.5+ 11.3 years were enrolled,including 94 in OB group and 580 in N-OB group respectively.Compared with those in the N-OB group,the proportion of male,age,mean arterial pressure,blood uric acid,blood triglyceride,diabetes mellitus and hypertension increased in OB group (all P ＜ 0.01).Patients in OB group had lower estimated glomerular filtration rate (eGFR) and higher ARR score than those in N-OB group (all P ＜ 0.05).(2) More severe thickening renal small artery wall and hyaline degeneration were observed in the OB group than in the N-OB group (all P ＜ 0.01).There was no statistical difference between the two groups in Lee classification,Oxford classification,mesangial cell proliferation,glomerular sclerosis,crescent formation,renal tubular atrophy,interstitial inflammatory cell in filtration and endothelial cell proliferation.(3) After adjusting for age,sex,blood uric acid,serum albumin,eGFR,low density lipoprotein,glomerular sclerosis,interstitial inflammatory cell infiltration,renal tubular atrophy and vascular wall thickening,BMI was still an independent risk factors for ARR in IgAN patients (OR=1.09,95％ CI 1.03-1.14).Conclusions BMI is an independent risk factors for ARR in IgAN patients.Early prevention and control of obesity and its associated risk factors may improve outcomes of IgAN patients.

Objective To describe the early use of nasal continuous positive airway pressure (nCPAP) ventilation for infants presenting acute congestive heart failure (CHF) complicated by congenital heart disease (CHD) and pulmonary artery hypertension (PH).Methods Sixty infants with CHD treated for acute CHF were randomly divided into the nCPAP group (n =32) and the non-nCPAP group (n =28).Data were analyzed,which included lactic acid value (Lac) by arterial blood gas analysis,calculation of oxygenation index [pa (O2)/FiO2],detection of serum N-terminal pro-brain natriuretic peptide of type B (NT-proBNP) level,determination of left ventricular end diastolic volume index (LVEDVI),left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) by noninvasive bedside ultrasonic cardiogram (UCG).Results 1.Comparison of arterial blood gas between the 2 groups:1 d after treatment,there were significant differences in pa (O2)/FiO2 and Lac between the 2 groups (t =4.743,5.402,all P ＜ 0.05).A significant difference was found in the pa (O2)/FiO2 between the nCPAP group and the non-nCPAP group 3-7 d after treatment(t =6.366,P ＜ 0.05).The level of Lac had no significant difference between the 2 groups 3-7 d after treatment(t =1.812,P ＞ 0.05).2.Comparison of index of heart function between the 2 groups:after 3-7 d treatment,LVEDVI,LVEF,and PASP were statistically different between the 2 groups (t =2.052,2.704,2.019,all P ＜0.05).3.Comparison of serum indexes between the 2 groups:3-7 d after treatment,serum NT-proBNP level was improved dramatically compared with the non-nCPAP group(t =9.869,P ＜0.05).4.Comparison of clinical prognosis between the 2 groups:the differences in needing endobronchial intubation rate,mechanical ventilation time,time in PICU and mortality rate were all statistically significant between the 2 groups (x2 =5.505,P =0.019; t =4.788,P =0.000;t =5.068,P =0.000 ;x2 =4.284 ;P =0.038).Conclusions The early use of noninvasive nCPAP for eligible patients with acute CHF complicated by CHD and PH seems to improve their prognosis by improving pa (O2)/FiO2,reducing left ventricular and right ventricular afterload and improving the left ventricular function.

Objective To study the effect of astragaloside on proliferation and apoptosis in human keloid fibroblasts.Methods The human keloid fibroblast ceils were treated with different concentration of astragaloside(10、20、40 ng/mL).Cell proliferation was detected by MTT,the gene expreesion levels and protein levels of apoptosis-related proteins,survivin,p53 and Bcl-2.were determined by real-time PCR and Western blot,respectively.Results Comparecl with control group(treated with 0 ng/mL astragaloside),the absorbance values (A490 nm) of each concentration group were significantly reduced,which suggest that the proliferation of all keloid fibroblast were markably inhibited in a dose-dependent way (P＜0.05).The gene expreesion levels and protein levels of apoptosis-related proteins,survivin、Bcl-2 were largely suppressed and P53 werelargely promoted in a dose-dependent.Conclusion The keloid fibroblasts cells proliferation and apoptosis could be regulated by astragaloside.

Objective To evaluate the value and clinical application of cardiac structure Z scores in children with preoperative tetralogy of Fallot (TOF) by echocardiography. Methods Considering the result of 31 patients who underwent echocardiography in Shenzhen Children’s Hospital before TOF repair from January 2011 to September 2013, the median age was 10 months (range:3 days to 14 years). Other 31 normal children were selected as normal control group with age-and sex-matched, the median age was 10 months (range: 6 days to 13 years). Echocardiographic measurements included the diameter of right ventricular outflow tract (RVOT), pulmonary valve diameter (PVD), left pulmonary artery diameter (LPAD), right pulmonary artery diameter (RPAD), pulmonary valve peak velocity (PV-Vmax), tricuspid annulus diameter (TVD), mitral annulus diameter (MAD), left ventricular end-diastolic volume (LVEDV) and left ventricular mass (LVmass). Shenzhen Children’s Hospital pediatric echocardiography normal reference values and the regression equation are applied to obtain the forecast average, and using the Z-score formula into the standard value (Z=[M-y]/ MSE ). Results There was no significant difference in body surface area between the TOF group and control group (P>0.05). Compared with control group, the true value of RVOT reduced significantly in TOF group, its Z-score showed negative values increase (-4.87±1.86 vs 0.33±0.93, t=-13.90, P<0.05). PVD, LPAD and RPAD reduced significantly in TOF group, those Z scores showed a negative value increase (-4.15±2.93 vs 0.11±0.85, t=-7.76;-1.35±2.38 vs 0.66±1.17, t=-4.24;-1.47±2.03 vs 0.59±1.04, t=-4.94;all P<0.05). While PV-Vmax increased significantly, and it’s Z score showed a positive value increase (8.38±0.19 vs 0.24±0.98, t=29.50, P<0.05). TVD of TOF patients was slightly larger than the control group (P=0.10), but the Z score was significant greater than the control group (1.00±1.17 vs 0.29±0.52, t=3.06, P<0.05). MV-D, LVEDV and LVmass of TOF patients were slightly decreased than the control group (all P>0.05), but the Z scores of TOF were significantly reduced than the control group (0.25±0.78 vs 0.76±0.65, t=-2.75;-0.92±1.94 vs 0.03±1.01, t=-2.41;-0.83±1.59 vs 0.67±0.69, t=-4.71; all P<0.05). The Z scores of RVOT, PVD, LPAD and RPAD had no significant difference between transannular patch surgery and pulmonary valve-sparing repair patients (-4.89±2.03 vs -4.84±1.67, t=-0.08; -4.73±3.49 vs -3.34±1.75, t=-1.31; -1.88±2.54 vs -0.62±2.00, t=-1.49;-1.89±1.90 vs-0.84±2.15, t=-1.41;all P>0.05). For the Z scores of PV-Vmax, there were no significant difference between transannular patch surgery and pulmonary valve-sparing repair (8.58±1.20 vs 8.12±1.16, t=1.07, P>0.05). Conclusions The Z scores value of cardiac structure can be used in quantitative analysis of RVOT obstruction and development of left ventricular backward of TOF. The Z score of transannular patch surgery is more lower than pulmonary valve-sparing repair patients. The normalized Z score by body surface area correction is important for the preoperative diagnosis and the surgical planning.

Objective To compare the efficacy of patient-controlled epidural analgesia (PCEA) with different concentrations of sufentanil plus levobupivacaine after caesarean section.Methods Ninety ASA Ⅰ or Ⅱ nulliparous patients who were at full term with a singleton fetus,aged 22-35 yr,weighing 60-85 kg,undergoing elective caesarean section under combined spinal-epidural anesthesia,were randomly divided into 3 groups (n =30each):0.125％ levobupivacaine plus sufentanil 0.4,0.6 and 0.8μg/ml groups (groups Ⅰ,Ⅱ and Ⅲ).The patients received 48 h of PCEA after operation.PCEA pump was set up with a background infusion of 2 ml/h,and a bolus dose of 2 ml with a lockout-interval of 15 min after a loading dose of 5 ml.VAS score was used to assess the intensity of pain (0 =no pain,10 =worst pain).VAS score ≤ 3 was considered as effective analgesia.VAS score ≥4 was considered as failure of analgesia,and the rescue analgesic was given.Venous blood samples were taken before operation and at 24 and 48 h after operation to detect the serum prolactin (PRL) concentration using radioimmunoassay.The degree of motor block of lower extremities was assessed and scored using modified Bromage scale.Maternal colostrum time,the number of attempts,and adverse effects including nausea and vomiting,pruritus,somnolence,respiratory depression,bradycardia,hypotension and urinary retention were recorded after operation.Results Compared with group Ⅰ,the number of attempts and rate of failure of analgesia were significantly decreased,the maternal colostrum time was shortened,and the serum PRL concentration at 24 and 48 h after operation was significantly increased in groups Ⅱ and Ⅲ,and the incidences of adverse effects such as nausea,vomiting and bradycardia were increased in group Ⅲ (P ＜ 0.05).Compared with group Ⅱ,no significant change was found in the number of attempts,rate of failure of analgesia,maternal colostrum time,and serum PRL concentration at 24 and 48 h after operation (P ＞ 0.05),and the incidences of adverse effects such as nausea,vomiting and bradycardia were increased in group Ⅲ (P ＜ 0.05).There was no significant difference in the modified Bromage scores among the three groups (P ＞ 0.05).Conclusion When sufentanil plus 0.125 ％ levobupivacaine are used for PCEA,the recommonded concentration of sufentanil is 0.6 μg/ml.