Ethics -related issues are the main problems encountered in living- donor renal transplantation in China.The most important ethical problems are informed fact,voluntary decision and informed consent for donors and recipients.Three problems need to be determined including content and limitation of informed fact,judgment of intellectual ability of the donor and recipient sides,and voluntary consent. Flexible principles and countermeasures should be well employed in different and comphcated clinical cases.For example,people with intellectual or mental disability and minors are not permitted to be donor in order to protect their legal rights and benefits.To draw a conclusion,it's necessary to give ethical interfere,legal control and social supervision to living -donor renal transplantation.The key - point of social and ethical interfere is to enhance the sense of socio - ethical responsibility among medial staffs.Hospital ethics committee should play their expected role in clinical application.

Objective To observe the changes in endothelin(ET), nitric oxide(NO) and C-reactive protein(CRP) before and after the rosiglitazone therapy in patients with impaired glucose tolerance(IGT). Methods 72 IGT patients were divided randomly into 2 groups: rosiglitazone group(n=45) and placebo group(n=27). 15 weeks later, the efficacy of rosiglitazone was compared. Results The levels of ET, CRP were decreased and NO increased significantly in rosiglitazone group compared with those before treatment (ET 54.8±10.0 pg/ml vs 72.8±24.3 pg/ml, P<0.01;CRP 4.58±0.38 mg/L vs 5.99± 0.85mg/L, P<0.01 ; NO 41.0±10.0 μmol/L. vs 31.3±9.0 μmol/L, P<0. 01)). However, the levels of ET,CRP and NO in placebo group did not change singnificantly (P>0. 05). Conclusions Rosiglitazone can singnificantly improve ET, NO, CRP level in IGT patients, which means an additional effect of rosiglitazone on the correlation of inflammation and endothelial disturbance.

Objective　To observe the therapeutic effects and safety of angiotensin-converting enzym e (ACE)-inhibitors in the treatment of the secondary erythromatosis following ren al transplantation.Methods　Twenty-four patients with erythromatosis following renal transplantation recei ved the treatment with ACE-inhibitors. During the administration of ACE-inhibi tors, the hemoglobin, hematocrit and the side effects were observed. Results　All the patients were recovered except one who ha d to be stopped the treatment of ACE-inhibitors because of the depressing of th e blood pressure. The time of producing the effects was 7-20 days. The side effe cts included lower blood pressure accompanied by dizzy in 3 cases, anemia in 2 cases and damage to renal function in 2 cases. Conclusions　ACE-inhibitors were effective in the treatme nt of secondary erythromatosis following renal transplantation. It was important to monitor the hemogram and the renal function of the patients.

OBJECTIVE:To discuss the effect of anti-tuberculosis therapy on plasma concentration of calcineurin phosphatase inhibitors in renal transplant recipients.METHODS:The change in plasma concentration of calcineurin phosphatase inhibitors in 2 renal transplant recipients who were complicated with tuberculosis infection before or after renal transplantation was analyzed.The patients were routinely treated with cyclosporine(CsA)or tacrolimus(FK506)+ mycophenolate mofetil(MMF)+ prednisolone(Pred).Monoclone fluorescence polarization immunoassay(FPIA)was employed to determine the concentration of CsA or FK506 in different time point before and after administration of antituberculosis drugs.RESULTS:Plasma concentration of CsA was down-regulated significantly by Rifampicin,and the daily dose of CsA has to be increased to more than 3 times the previous concentration before meeting the target concentration.The concentration of FK506 was slightly down-regulated by rifapentine.CONCLUSION:The concentration of CsA or FK506 and the adverse effect of antituberculotic drugs should be closely monitored for renal transplant recipients complicated with tuberculosis infection.

Informed consent is one of the basic ethical rules for living related kidney transplantation.Doctors have obligations of informing before kidney transplantation.The advantages and disadvantages of each treatment should be introduced to uremic patients and their relatives to let them know that kidney transplantation is not the only choice for treating uremia.Both donors and recipients of living kidney transplantation should be informed of the clinical effects,all kinds of complications and their risks,and the importance of treatment compliance after operation.Donors should be notified with the interests,complications and risks in period of donating operation and long-term after operation,and should be notified with the interests and risks in some special conditions for exchanging donation.Voluntary donation should fulfill that donators make the decision of donation under a fully understanding of the risks of living kidney transplantation and being fully assessed by themselves,and cheating,luring and sealing kidneys for economic interests are ruled out in making consent.Persons with incapability can not be donors even if they had made the consents of donation.In order to make sure that the decision of donation is made under the condition that living donors and recipients have known the fact thoroughly,ethics committee should inspect the "consent of kidney transplantation of living donation" and "consent of operation" offered to donors and recipients by hospital to make sure that donors and recipients have been fully notified with the current situation,clinical effects and possible complications of living kidney transplantation by doctors.This measure can make sure that donors and recipients make the decision based on knowing the fact thoroughly and sign the consent personally.

Objective To explore the clinical effect of renal artery embolization for renal graft dysfunction.Methods A total of 17 patients with renal graft dysfunction were treated by embolizing the renal graft artery.Coil embolization was performed on 7 of the cases,and gelfoam combined with coil was used in the other 10.Results Among the 17 patients,14 discontinued immunosuppressant in 3 weeks after the embolization,and 2 discontinued after receiving low-dose cortisones for about 6 months,and showed good recovery during follow-up.The other patient underwent resection of the renal graft because of continuous fever and graft pain.After the embolization,14 cases developed 'post-embolization syndrome'.Coil migration occurred in 1 case during the procedure.One patient experienced angina during the operation,and developed myocardial infraction the day after the embolization.Conclusions Renal artery embolization is safe and effective for patients with renal graft dysfunction.By using the method,open surgery can be avoided.Attention should be paid to potential complications.

Objective To investigate the effect of heart preservation solution containing pinacidil on mitochondrial function in isolated rat hearts. Methods One hundred and twenty pathogen-free SD rats of both sexes weighing 250-350 g were used in this study. The animals were anesthetized with intraperitoneal pentobarbital 65 mg/kg. Their hearts were immediately removed and perfused in a Langendorff apparatus. Left ventricular enddiastolic pressure was measured from a fluid-filled latex balloon inserted in the left ventricle. The isolated hearts were randomized into 5 groups (n = 24 each):group Ⅰ was perfused with cardioplegic solution HTK; group Ⅱ with HTK containing pinacidil (a non-specific sarcKATP and mitoKATP channel opener) 0.5 mmol/L; group Ⅲ with HTK containing pinacidil 0.5 mmol/L + 5-HD (a selective mitoKATP channel blocker) 100 μmol/L; group Ⅳ with HTK containing pinacidil 0.5 mmol/L + HMR-1098 100 μmol/L (a selective sarcKATP channel blocker) and group Ⅴ with HTK containing pinacidil 0.5 mmol/L + 5-HD 100 μmol/L + HMR-1098 100μmol/L. The isolated hearts were perfused with simple HTK or HTK containing pinacidil or pinacidil + 5-HD and/or HMR 20 ml/kg at 10 ml/min and then removed from Langendorff apparatus and dipped into the same HTK solution for 8 h at 4 ℃followed by 60 min reperfusion. The respiratory function of mitochondria (respiratory control rate (RCR), the rate of oxygen consumption in state 3/state 4 and P/O) was measured at the end of equilibration (T1) after 8 hpreservation (T2) and at the end of 60 min reperfusion (T3). The CK-MB and LDH activities and cTnI expression in myocardium was detected at T1 and T3. The ultrastructure of myocardium was examined at T3. Results Perfusion suspension-reperfusion (PS/R) significantly decreased mitochondrial respiratory function (RCR, P/O and rate of O2 consumption in state 3) and increased myocardial cTnI concentration and CK-MB and LDH activities at T3 compared with baseline at T1 in group Ⅰ. Pinacidil significantly increased mitochondrial respiratory function (RCR, P/O and rate of O2 consumption in state 3) and decreased myocardial cTnI concentration and CK-MB and LDH activities in group Ⅱ as compared with group Ⅰ-indicative of protective effect of pinacidil on mitochondria against PS/R injury. The protective effect of pinacidil against PS/R injury was attenuated by 5-HD and/or HMR1098. The myocardial damage was slightest in group Ⅱ . Conclusion Both sarcolemmal and mitochondrial KATPchannel are involved in the protective effect of pinacidil against PS/R-induced myocardial damage during heart preservation.

Objective To discuss the spiral CT features of lymph node metastasis in advanced gastric cancer, and to investigate the correlation between spiral CT features and pathologic results. Methods Spiral CT scan and triphasic enhancement spiral CT scan were performed in 59 patients with advanced gastric cancer before operation. Results ①The pathologic metastatic rate of lymph node in gastric cancer was high when the lymph nodes were nubby-mixed, prominently enhanced, unsymmetrical enhanced and ≥9 mm in diameter on spiral CT (P<0.05). ②The detection rate of lymph node metastasis with spiral CT was high when carcinoma tissues were poorly differentiated, Borrmann Ⅲ+Ⅳ, T3-4 staging and TNM Ⅲ+Ⅳ staging. Conclusion The spiral CT features of lymph node (distributing type, size, enhanced degree, enhanced mode and staging) can reflect the pathologic characteristics of lymph node metastasis in gastric carcinoma. Pathologic characteristic of gastric tumor determines the detection rate of lymph node metastasis on spiral CT. The accuracy of CT to diagnose lymph nodes metastasis will be improved by integrating the spiral CT features of both gastric tumor and lymph node.

BACKGROUND:With the development of genetic engineering and tumor molecular biology, gene therapy for tumors has become a new treatment modality.
OBJECTIVE:To explore the effect of the KDR gene silencing on the proliferation and invasion capacity of breast cancer MCF-7 cel s.
METHODS:Interfering RNA (siRNA) sequences for smal molecule KDR gene was designed and transferred into human breast cancer MCF-7 cel s. Then, RT-PCR and western blot assay were used to detect the KDR mRNA and protein expression. Flow cytometry, cel counting kit-8 test and Transwel test were employed to detect the cel cycle, proliferative capacity and invasion capacity of breast cancer MCF-7 cel s after the KDR gene silencing.
RESULTS AND CONCLUSION:After 48 hours of KDR silencing, the mRNA and protein expressions of KDR in MCF-7 cel s were decreased obviously;MCF-7 cel s arrested at G0/G1 stage and the number of cel s at S stage was reduced. Cel proliferation was inhibited significantly. The amount of cel s passing through the filtering membrane became less. After KDR gene silencing, the proliferation and invasion of breast cancer MCF-7 cancer stem cel s were inhibited remarkably, indicating that KDR gene silencing may be a new target for the effective treatment of breast cancer.