Objective To analyze factors influencing β-blocker response rates of patients with portal hypertension and to explore the effect of nursing interference for increasing response rates with goal-directed nursing model. Methods 83 cases of portal hypertension were enrolled.Questionnaire about medical visiting behaviors and medication compliance were compared and analyzed after routine medication for 3 months.Bivariate and multivariate regression analysis were performed and related factors were used to establish a goal-directed nursing model for nursing interference guidance.52 non-response patients were randomly divided into the study group(27 cases)and the control group(25 cases).In the study group,compensation system and supportive-education according to Orem model were given,while the control group was given routine nursirng.Response rates and related factors were compared after 3 months of nursing intervention. Results Awareness of self-care responsibility,knowledge about the medication target,risk of sudden drug withdrawal,related medical knowledge,ability for pulse rate measurement and dose adjustment according to pulse rate changes were related to the response rates.Multivariate regression analysis showed that awareness of self-care responsibility,sudden drug withdrawal,utilization of social support and regular return visit were the independent factors.In the study group,ability for pulse rate measurement and dose adjustment acconding to pulse rate changes improved,phenomenon of sudden drug withdrawal declined and response rate increased,comparing with the control grpup. Conclusins For patients fail to respond to β-blockers,compliance behavior and medication compliance should be analyzed,and much attention should be paid to the education of the related medical knowledge,risk of sudden drug withdrawal and drag using targets.Goal-directed medel could be a guidance for nursing intervention to increase the response rates.

Objective To investigate the preventive effects of emilia sonchifolia on experimental hepatic steatosis in rats and its molecular mechanism.Methods Seventy Sprague-Dawley (SD) rats were randomly divided into five groups: normal control, model, high dose emilia sonchifolia, low dose emilia sonchifolia groups and high dose emilia sonchifolia + phosphorylated extracellular signal regulated protein kinase 1/2 (pERK1/2) inhibitor (PD98059) group (PD group). In normal control group, the rats were fed with normal diet, and in the other four groups, the rats were fed with high fat and low protein diet combined with 30% carbon tetrachloride (CCl4) peanut oil 2 mL/kg subcutaneous injection, once every 3 days for consecutive 3 weeks to establish animal models with hepatic steatosis. In emilia sonchifolia high and low dose groups, 5.0 g/kg and 2.5 g/kg doses of emilia sonchifolia were given respectively by gavage, once a day. In PD group, after administration of emilia sonchifolia high dose by gavage once a day, additionally PD98059 0.3 mg/kg was injected through a tail vein, once a week. After 3 weeks, all rats were switched to normal diet and treatment continued as before. At the end of the 5th week, liver tissues were taken for pathological analyses. The serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total cholesterol (TC), and triglyceride (TG) were determinated by automatic biochenical analyzer. The positive cell count and protein expressions of sterol-regulatory element binding protein 1 (SREBP-1), pERK1/2, toll like receptor 4 (TLR4) and high mobility group box-1 protein (HMGB1) were tested by immunohistochemistry, Western Blot and flow cytometry. The levels of superoxide dismutase (SOD) and malonaldehyde (MDA) in liver cell homogenate were detected by hydroxylamine and TBA method.Results Compared with the model group, the lobular inflammation in high and low dose emilia sonchifolia groups and PD group was attenuated (1.50±0.53, 1.80±0.43, 1.20±0.42 vs. 2.30±0.48), and ALT, AST, TC, TG, SREBP-1, and MDA were significantly decreased, the decrease in high dose emilia sonchifolia group being the most significant [ALT (U/L): 51.91±6.95 vs. 66.50±12.15, AST (U/L): 125.70±5.62 vs. 147.10±10.52, TC (mmol/L): 1.79±1.04 vs. 2.81±1.08, TG (mmol/L): 0.87±0.55 vs. 1.17±0.67, SREBP-1: (30.60±5.56)% vs. (53.10±5.02)%, MDA (nmol/mg): 5.20±0.87 vs. 10.61±5.45,P < 0.05 orP < 0.01]; the relative expression levels of pERK1/2, TLR4, and HMGB1 showed no statistically significant differences between each treated group and the model group [pERK1/2: (43.77±4.93)% vs. (46.83±5.27)%, TLR4 (rmfi): 69.12±24.64 vs. 69.08±24.32, HMGB1 (rmfi): 22.93±14.88 vs. 33.17±13.29, allP > 0.05]. While the above index values in PD group were close to those in high dose emilia sonchifolia group, showing that PD98059 had no impact on emilia sonchifolia's action.Conclusions Emilia sonchifolia can alleviate hepatic injury and attenuate lobular inflammation in rat experimental hepatic steatosis. Its mechanism is possibly related to the reduction of oxidative stress reaction, and SREBP-1 may be as a mediator involved in the action.

Objective To discuss how to assess scientifically on the outcome of clinical application with peripheral nerve graft materials. Methods All Pubmed database from 1990 to 2010 were retrieved,and searched the English literatures about the application with peripheral nerve graft materials. The literatures consisted of original clinical research and review excluding animal experiments, repetitive research and irrelevant literatures. The clinical trials data of U.S. was also our target. The information about the safety and effectiveness of peripheral nerve graft materials and related statistical problems were discussed. Results Totally 1578 literatures were identified. Following reading titles and abstracts, we excluded some irrelevant articles. Finally 31 literatures and 2 issue of clinical research from clinical trial data of U.S. were included. After analysis on the literatures, we gained the following results: a remarkable degree of homogeneity among patients can be formed by setting the inclusion and exclusion criteria. For the assessment of proper digital nerve repair, Macknnon- Dellon evaluation is commonly applied, but for the composite nerve, BMRC evaluation is the main method and electromyography can be used as a secondary choice. The safety of peripheral nerve graft materials cannot be evaluated throughout one's life according to the current level of science and technology. It should be evaluated by long-term clinical observation. Randomized clinical trials with random grouping was a gold standard for clinical trials with a good balance and strong comparability. However, non-randomized controlled trials also have an important value. Conclusion It is impossible to make all affected factors homogeneity in a limited timespace conditions of clinical trial. However, we can try our best to keep factors homogeneity to maximum degree by setting the inclusion and exclusion criteria. The scientific assessment of outcome of peripheral nerve repair can be carried out with reasonable and internationally recognized nerve function evaluation methods, strict follow-up time and statistics programme meeting the clinical requirement.

Objective:To investigate the effect and the related mechanism of H19 on the invasion and migration ability of pancreatic cancer cells.Methods: The expression of H19 in tissues of pancreatic carcinoma and non-carcinoma adjacent tissues of pancreatic carcinoma were detected.qPCR was used to detect the expression of H19 in different pancreatic cancer cells.The migration and invasion ability of pancreatic cancer cells was detected after silencing H19 using wound healing assays and Transwell matrigel invasion assays.Dual-Luciferase Reporter Assay System was used to detect miR-107regulating H19.The expression of miR-107 in tissues of pancreatic carcinoma and non-carcinoma adjacent tissues of pancreatic carcinoma were detected.The regulation of miR-107 on the migration and invasion ability of pancreatic cancer cells were detected after silencing H19 using wound healing assays and Transwell matrigel invasion assays.Subcutaneous tumor was used to detect the size and volume of the tumor after inject the tumor cells.Immunohistochemistry was used to detect the expression of Ki67 and PCNA.Results: Compared with non-carcinoma adjacent tissues of pancreatic carcinoma,the expression of H19 of tissues of pancreatic carcinoma was significantly increased.The expression of H19 in pancreatic cancer cell A549 was highest.Silencing H19 could inhibit the migration of human pancreatic cancer A549 cells.miR-107 was the direct target of H19.Compared with non-carcinoma adjacent tissues of pancreatic carcinoma,the expression of H19 of tissues of pancreatic carcinoma was significantly decreased.After silencing H19,inhibiting the expression of miR107 could inhibit the migration of human pancreatic cancer A549 cells.Compared with the group of H19-siRNA,H19-siRNA+miR-107-inhibitor group mice tumor volume and weight were significantly bigger.Immunohistochemistry showed that compared with H19-siRNA group,the expression Ki67 and PCNA expression in H19-siRNA+miR-107-inhibitor group increased.Conclusion: H19 plays the role of tumor promotor factor in pancreatic cancer.H19 can affect the invasion and migration ability of pancreatic carcinoma cells by regulating miR-107.

Report a case sustained Gustilo type III C open fracture of the left humerus with brachial artery injury who has limb ischemia and wound infection after operation in June, 2014. To salvage the limb, performed cross limb vessel transfer to restore blood supply at one-stage. After multiple debridement, Flow-through flap transfer was performed for definitive reconstruction of the arterial injury and repair the wound in secondary stage. In the 3rd stage, cutting the pedicle of transposition vessels. Follow-up at 1 year after surgery, the patient's left upper limb had survived with limited movement and confirmed Flow-through the vessel reconstruction using CTA.

The career development of young doctors is related to the future of medicine as a whole. Medicine is a subject that needs to be researched. Diagnosis and treatment work. The importance of scientific research for the development of medicine is self-evident. In addition to clinical work, young doctors need to take scientific research into account. We will provide the key elements in a road map of a successful scientific research for young doctors.

Objective:To confirm the reuse of mismatched regenerated motor axons of brachial plexus and explore the effect of target organs on their regeneration in a rat model.Methods:This study was carried out between January 2021 and December 2021 at the research laboratory of the Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University. Animals were randomly assigned into 2 groups, as a regeneration group (RGen) with 5 subgroups and a reuse group (RUs) with 3 subgroups. There were 6 rats per subgroup with 42 rats in total. It was observed that in the groups of RGen1-4, after the transection and suture of the musculocutaneous nerve, the motor axons of the proximal end could accurately grow into the distal corresponding endoneural tube. It was also observed that in the mismatched regenerated group, motor axons were the axons that grew into the endoneurial tube of the lateral forearm cutaneous nerve (LFCN), and other non-target organ contacts were made to the regenerated nerves after mismatch. It was specifically further divided into RGen1, the group without an organ for nerve to make contact with; RGen2, the group with skin as the target organ with nerves contact by neurorrhaphy; RGen3, the group with skin as the target organ with originally reserved natural nerve contact; RGen4, the group with muscle as the target organ with nerves contact by neurorrhaphy and RGen5, a control group. After 8 weeks, the positive area (PA), mean density (MD) and integral optical density (IOD) were measured, with AChE and ChAT fluorescence staining of the medial branch of LFCN, to evaluate the regenerated nerves after mismatch. Of the RUs group, firstly, the innervating branches of the flexor carpi radialis (FCR) were dissected and exposed, then further assigned according to initially innervated FCR (RUs1), contacted with regenerated nerves after mismatch (RUs2) and denervated (RUs3), respectively. After 8 weeks, compound muscle action potential (CMAP) and wet weight ratio of FCR were taken. Masson staining of FCR was also performed to evaluate muscle reinnervation by the regenerated nerves after mismatch. Data analysis with One-Way ANOVA and Bonferroni 0.05 indicated a statistically significant difference.Results:In the RGen groups, after AChE staining, the PA, MD and IOD of RGen3 and RGen4 were higher than that of RGen1 and RGen5, and PA of RGen4 were higher than that of RGen2, with a statistically significant difference ( P<0.05). After ChAT staining, the values of PA and IOD of RGen3 and RGen4 were higher than that of RGen1 and RGen5, and PA of RGen4 were higher than that of RGen2, with a statistically significant difference ( P<0.05). In the RUs, electrophysiological assessment showed that no CMAP was observed in RUs3, there was no significant difference in Latency of RUs1 and RUs2. The difference was statistically significant ( P<0.05). Wet weight rate of muscle of RUs1 (98.91%±3.86%) was higher than that of RUs3 (86.67%±4.68%) with a statistically significant difference ( P<0.01), but no significant difference when compared with RU2 (92.74%±3.88%). Masson staining showed that the CVF value of RUs2 (8.61%±1.16%) was significantly higher than that of RUs1 (3.17%±0.76%), and statistic significantly lower than that of RUs3 (16.44%±2.26%)( P<0.01). Conclusion:Target organ contact can promote the regenerated nerves after mismatched regeneration, and the muscle target organs exhibit greater facilitation than the cutaneous target organs. Besides, regenerated nerves after mismatch can establish effective innervation with muscle target organs, comfirming their effective reuse.