Prednisone-Free Maintenance Immunosuppression—A 5-Year Experience

Concern persists that prednisone-free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and graft loss. We herein report 5-year follow-up of a trial of prednisone-free maintenance immunosuppression. From October 1, 1999, through January 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death-censored graft survival, 92%; acute rejection-free graft survival, 84% and chronic rejection-free graft survival, 87%. The mean serum creatinine level (+/-SD) at 1 year was 1.6 +/- 0.6; at 5 years, 1.7 +/- 0.8. In all, 86% of kidney recipients with functioning grafts remain prednisone-free as of April 30, 2005. As compared with historical controls, recipients on prednisone-free maintenance immunosuppression had a significantly lower rate of a number of complications, including cataracts (p < 0.001), posttransplant diabetes mellitus (p < 0.001), avascular necrosis (p = 0.001), and fractures (p = 0.004). We conclude that prednisone-related side effects can be minimized in a protocol incorporating prednisone-free maintenance immunosuppression. Five-year graft outcome remains good.     

Immunosuppression: evolution in practice and trends, 1993–2003

Immunosuppression trends for solid organ transplantation have undergone a perceptible shift over the past decade. This period is of interest because it was during this time that the Food and Drug Administration (FDA) expanded the variety of medications to allow for alternatives in immunosuppressive management. An organ-by-organ review of SRTR data identifies several important trends. Antibody induction continues to be used for the majority of kidney (70%) , simultaneous pancreas-kidney (SPK, 79%) pancreas after kidney (PAK, 74%), and intestine recipients (74%). It is used for under half of thoracic organ recipients and remains uncommon for liver transplant recipients (20%). The type of antibody preparation utilized has shifted from muromonab-CD3 and horse ATG to rabbit ATG and monoclonal anti-IL-2 receptor antagonists. Calcineurin inhibitors continue to be used for maintenance immunosuppression for most recipients, although there has been a shift from cyclosporine to tacrolimus. A clear transition is apparent in the choice of antimetabolite from azathioprine to mycophenolate mofetil. Although corticosteroids continue to be used as maintenance immunosuppression for most recipients prior to discharge, there is evidence that efforts of steroid avoidance protocols are having an impact across all organs, as slight decreases in their use have been observed.     

SOS抢救护理小组的组建与实施

介绍了上海交通大学附属一院SOS抢救护理小组的组建、运营和管理,提高了抢救病人的医护应急速度、效率和质量、并有利于护理队伍的培养和急救护理学的发展。     

上海现代医疗卫生服务业发展现状分析

该文在对现代医疗卫生服务业进行概念界定的基础上，综合分哲了现代医疗卫生服务业的特点，以及上海加速发展现代医疗卫生服务业所具备的有利条件和面临的制约因素.     

当前高校设备维修管理服务SWOT分析与战略探讨

随着高校对教学科研仪器设备投入的不断增加，仪器设备维修工作的重要性日益突出。通过SWOT分析法，对高校设备维修服务的内外因素进行分析，找出当前高校设备维修工作的内在优势和弱势、外在机会和挑战，并提出在高校设备维修服务战略方面的进攻调整防御和生存四种相应策略的思考。     

论以服务对象为中心的医院管理道德原则

以服务对象为中心，就是医院管理者在医院工作管理过程中，从维护病人和服务对象的利益出发，将以为服务对象服务，满足服务对象合理医疗保健需求作为医院各项工作的中心，把服务对象至上、一切为了病人和服务对象的医院管理道德要求落实到各项管理措施之中。     

Dynamic observations on NK cell activity and IL-2 and IFNγ productionin vitro in patients on maintenance hemodialysis

Summary In order to study the immune function of patients on maintenance hemodialysis (MHD), we assayed NK cell cytotoxicity against K⁵⁶² targets in 40 patients on MHD, and the production of IL-2 and IFN in peripheral blood mononuclear cells (PBMC) after PHA stimulation, in contrast to those in normal controls. The results showed that NK cell activity and IL-2 and IFN levels were markedly lower in the patients than in the controls. Afeter a single dialysis, NK cell activity as well as IL-2 and IFN levels were elevated to different extent. But there was no significant change in patients after long-term dialysis. There was a positive correlation between the NK cell activity and IL-2 and IFN activity in the controls, but no such correlation was found in the patients on MHD. There was a positive correlation between the NK cell activity and IL-2 activity in patients after dialysis, suggesting that immune function were impaired in the patients on MHD, with a decline in the activity of NK cell and IL-2 and IFN, and a disorder of immune regulation cycle. These abnormal immune impairments in the patients could be partly corrected by hemodialysis. However, long-term hemodialysis is not much helpful in the improvement of patient’s immune function.     

联勤后我分部医院开展优质服务的做法

为探讨军队医院联勤后开展联勤优质服务工作的管理，本介绍了我分部所属医院开展优质服务的做法，即：端正服务态度，增强服务意识，狠抓内涵建设，提高服务质量，改善医疗设备，美化诊疗环境，完善制度措施，加强监督管理等落实联勤优质服务。     

应重视生化分析仪的安装使用与维护

本文论述了安装生化分析仪对实验室的基本要求以及生化分析仪使用时应遵守的一些基本原则，对生化分析仪使用过程中出现的故障进行了分类，明确了故障原因和责任，强调了日常维护的重要性及自动和半自动生化分析仪的维护要点。     

贫困山区育龄妇女健康状况调查分析

育龄妇女的健康状况。可以反映一个地区的社会经济发展水平，也可反映当地医疗保健服务的水平以及群众利用服务的能力。通过对贫困山区岳西县555名育龄妇女的健康状况及影响因素进行分析，发现常见病、多发病仍威胁贫困山区育龄妇女的健康，同时家庭经济状况直接影响农村育龄妇女对卫生服务的利用。