Objective To compare the therapeutic effect of endoscopic variceal ligation (EVL) and β-blockers plus isosorbide mononitrate (ISMN) in prevention of esophageal varieeal re-bleeding. Methods The randomized clinical trials (RCTs) on EVL and β-blockers plus ISMN for the prevention of esophageal varieeal re-bleeding were searched, and only the results from those with Jadad score higher than 3 were eval-uated with RevMan 4. 2 software for odds ratio (OR) with 95% confidence intervals (95%C1). Analysis of sensitivity was performed on the quality of the data and publication bias was investigated with funnel plots. Results Four trials matched the criteria were recruited including 504 cases with a follow-up from 8 to 25 months. There was no significant difference in rates of re-bleeding (OR =0. 93, 95% CI =0. 41 ～ 2. 11 ; P = 0. 87), re-bleeding due to esophageal varices (OR = 0. 68, 95% CI = 0. 19 ～ 2. 37 ; P = 0. 54), therapy-re-lated adverse effects (OR = 1.12, 95% CI =0. 75 ～ 1.67, P = 0. 57), severe adverse events (OR = 0. 89, 95% CI =0. 47 ～ 1.67, P = 0. 71), bleeding-related mortality (OR = 2. 11, 95% CI = 0. 88 ～ 5.08, P = 0. 10), or overall mortality (OR = 1.46, 95% CI = 0. 95 ～ 2. 24, P = 0. 09) between EVL and β-blockers plus ISMN groups. However, a trend towards lower bleeding-related mortality and overall mortality favored drug therapy. There was no heterogeneity found in the outcomes apart from re-bleeding (P = 0. 003) or re-bleeding from esophageal varices (P <0. 0001). The result of sensitivity analysis remained statistically sta-ble. Symmetric funnel plots showed there was no evidence of publication bias. Conclusion EVL and β-blockers plus ISMN show an equivalent efficacy and safety for the prevention of esophageal variceal re-bleed-ing. There is a trend towards lower bleeding-related mortality and overall mortality in drug therapy. But EVL is free from drug-related side effects, and its adverse events are similar to those of drug therapy. Thus, either of the two approaches can be used as the first choice for prophylaxis of re-bleeding of esophageal varices.

Objective To investigate the pathogenesis of cerebral watershed infarction (CWI) through analyzing the appearance examined by Color duplex Imaging(CDI) and transcranial doppler (TCD).Methods One hundred and forty-two patients with CWI diagnosed by magnetic resonance imaging(MRI) were enrolled in the study group and 150 patients with acute cerebral infarction were enrolled in the control group.The results of CDI and TCD were retrospectively analyzed of the two groups.The vascular stenosis,plaque detection rate,plaque characteration,plaque scores,the cause of low blood volume,intracranial collateral circulation were compared between the two groups to investigate the pathogenesis of CWI.Results Among the 142 cases in the study group,there were 72 cases of severe stenosis and occlusion,21 cases of moderate stenosis,31 cases of mild stenosis and 18 cases without stenosis and there were 19 cases of severe stenosis and occlusion,41 cases of moderate stenosis,23 cases of mild stenosis and 67 cases without stenosis among the 150 cases in the control group.There were significant differences in the two groups (x2 =66.583,P =0.000).There were significant differences on the plaque detection rate between the two groups (80.99％ (115/142) vs 49.33％ (74/150),x2 =32.010,P =0.000).There were significant differences on the scores of plaque between the study group and the control group ((11.47 ± 3.78) points vs (6.57 ± 3.53) points,t =4.019,P =0.001).There were significant differences on the defined cause of low blood volume between the study group and the control group (54.93％ (78/142) vs 11.33％ (17/150),x2 =63.164,P =0.000).There were 50 patients had collateral circulation in the study group and 38 cases in the control group,there were no significant differences between the two groups (35.31％ (50/142) vs 25.33％ (38/150),x2 =3.381,P =0.066).Conclusion Angiostegnosis,microemboli from the unstable atherosclerosis plaque,lower perfusion on the basis of hypovolemia are all the pathogenesis of CWI.CDI combine with TCD can provide more information in vascular evaluation and treatment.

Objective To compare the effects of different anesthetic and postoperative analgesic methods on the immune function of helper T lymphocytes and tumor metastasis after orthotopic liver cancer resection in rats.Methods Orthotopic liver cancer was induced by intrahepatic tumor implantation (IHTI) with Morris hepatoma 3924A.Thirty male ACI rats receiving IHTI,aged 12-18 weeks,weighing 240-300 g,were randomized into 3 groups (n =10 each) using a random number table:control group (group C),general anesthesia combined with epidural block-postoperative epidural analgesia group (group GE + EA),and general anesthesia-postoperative intravenous analgesia group (group G + IA).The liver cancer resection was performed on 14th day after IHTI,group G + IA inhaled 5％ sevoflurane for induction of anesthesia and inhaled 2％-3％ sevoflurane and received intraperitoneal injection of morphine 20 μg/100 g for maintenance of anesthesia.In group GE + EA,general anesthesia was performed as the method previously described in group G + IA,and epidural block was performed with 0.25 ％ bupivacaine 25 μl after tracheal intubation.Within 3 days after operation,0.125 ％ bupivacaine 150 μl + morphine 20 μg were injected daily via an epidural catheter once every 4 h (25μl per time) for postoperative analgesia in group GE + EA,and postoperative analgesia was performed with intraperitoneal morphine 240 μg injected daily once every 4 h (40 μg per time) in group G+ IA.Before surgery (T1) and on 2nd,7th and 30th days after sugery (T2-4),blood samples were collected to detect the levels of plasma interferon-γ (IFN-γ),interleukin-4 (IL-4),IL-17,IL-10 and tumor growth factor-β1 (TGF-β1).IFN-γ/IL-4 ratio was calculated.The rats were sacrificed after collecting blood samples at T4,and the development of abdominal lymph node metastasis,malignant ascites,implantation metastasis to abdominal wall and visible pulmonary metastasis nodules were observed.Results Compared with C group,the incidence of pulmonary metastasis,abdominal lymph node metastasis,and malignant ascites was significantly decreased,the plasma IFN-γ and IL-17 levels at T2 and IL-4 and TGF-β at T2,3 were increased,and IFN-γ/IL-4 ratio was decreased at T2,3 in group G+ IA,and the incidence of pulmonary metastasis,abdominal lymph node metastasis,malignant ascites and implantation metastasis to abdominal wall was significantly decreased,the plasma levels of IFN-γ,IL-4,IL-17,IL-10 and TGF-β1 were increased at T2(P ＜ 0.05),and no significant change was found in IFN-γ/IL-4 ratio in GE + EA group (P ＞ 0.05).Compared with G + IA group,the incidence of pulmonary metastasis and abdominal lymph node metastasis was significantly decreased,the plasma levels of IFN-γ and IL-17 at T2 and IL-4 and IL-10 at T3 were decreased,the plasma levels of IFN-γ at T4 and TGF-β1 at T2 and IFN-γ/IL-4 ratio at T3,4 were increased in GE + EA group (P ＜ 0.05).Conclusion The inhibitory degree of the immune function of helper T lymphocytes is decreased and development of tumor metastasis is reduced after orthotopic liver cancer resection in rats when general anesthesia combined with epidural block-postoperative epidural analgesia is applied as compared with those when general anesthesia-postoperative intravenous analgesia is applied.

The effects of mifepristone (RU486) on the productions of plasminogen activator and progesterone in rat granulosa cells and luteal cells were studied by fibrin overlay method and radioimmunoassay method. The results showed that RU486 could significantly antagonize tPA activity and progesterone production enhanced by human chorionic gonadotropin (hCG). Secretion of tPA from luteal cells was significantly promoted by RU486 with or without prostaglandin F2a (PGF2α), but progesterone production in luteal cells was markedly inhibited with the same treatment. With method of tissue culture, the results showed that RU486 was capable of stimulating tPA and urokinase (uPA) activity in endometrium of pregnant rats. These findings indicated that antifertility of RU486 might be partly mediated through plasminogen activator-plasminogen activator inhibitor system.

The human ovarian mucinous cystadenocarcinoma (hOMC) cells were co-cultured with antisense oligodeoxynucleotide (antisense ODN), nonsense ODN, and follicle-stimulating hormone (FSH) at different concentrations for the purpose of observing the effects of antisense ODN to FSH receptor (FSHR) on the proliferation and apoptosis of cultured hOMC cells in vitro. The inhibitory rates of growth were measured by using MTT method on the 2nd, 4th, 6th, 8th and 10th days after the interference of antisense ODN, nonsense ODN, and FSH, respectively. The apoptotic rates and the cell cycles were determined by means of flow cytometry, the apoptosis indexes were detected by using TUNEL, and the expression of caspase-3 was measured by using SP immunohistochemistry. Compared with that in the control group, the proliferative activity of hOMC cells was increased obviously in FSH groups (P<0.05 or P<0.01), decreased distinctly in antisense ODN groups (P<0.05 or P<0.01), and unchanged in nonsense ODN groups, respectively. Meanwhile, antisense ODN could significantly antagonize the FSH-promoted cell proliferative activity (P<0.01). Compared with those in the control group, the apoptotic rates and the expression of caspase-3 were dramatically increased in the mid-and high-dose antisense ODN groups (P<0.05 or P<0.01), while the number of cells in G(1)/G(0) phase was significantly decreased and that in S phase distinctly increased (P<0.01). There was no change in nonsense ODN groups (P>0.05). It was suggested that FSH may improve the development of hOMC cells. However, antisense ODN could inhibit proliferative activity and the FSH-promoted proliferative activity in hOMC cells, at the same time, antisense ODN could inhibit hOMC cell growth by inducing apoptosis.

AIM:The effective abortifacient drug,mifepristone,was incorporated in the solid lipid nanoparticles (SLNs). The aim of this paper was to study the influence of ratios of drug to lipid on the characteristics of SLNs.METHOD:The physicochemical properties of the fine dispersed systems,such as the size distribution,Zeta potential had been analyzed by laser diffractometry(LD).The measurements of entrapment efficiency(EE)and thermal analysis of DSC were performed as well.RESULT:It was showed if the weight of lipid remained unchanged,the mean particle size of SLNs increased with the increase of drug amount.Drug entrapment efficiency was the highest while about 50 mg drug was loaded on weight 1 g lipid.Simultaneously,the charge of Zeta potential agreed well with the amount of free drug in the colloidal system.DSC analysis results showed that the melting peak of mifepristone at approx.190 ℃ disappeared.CONCLUSION:It was evidence that the drug incorporation would affect the average particle size and Zeta potential of the colloidal systems and the physical state of crystalline drug mifepristone in SLNs was present in the amorphous form or molecularly dispersed at even so high adding amount of 250 mg/g(lipid),which there was no report about the physical state of the drug and SLN with so high drug-loading.It was suggested that the model drug mifepristone could influence the property of nanodispersion system and the crystalline character of the drug was altered by the nanometer carrier system vice versa.

Objective:To investigate the effect of the ceramometal b ridge on the local gingival groove flora.Methods: Classi cal bacterial incubation and identification were used to study the changes of th e local gingival groove flora in 6 patients wearing ceramometal bridge for 1 wee k to 3 months. Results: 3 months after the prosthetic procedure the CFU o f P.melaninogenica, Gram-positive bacilli cmainly Actinomyces and the t otal bacteria were significantly increased (P

Objective To investigate the correlation between Toll-like receptor 4 (TLR4) single nucleotide polymorphism (SNP) and the risk,severity and prognosis of sepsis in Chinese patients of Han nationality.Methods One hundred and three Han nationality patients who developed sepsis after surgery,aged 18-80 years,were enrolled in the sepsis group,and 114 Han nationality patients without sepsis after surgery,aged 18-80 years,were enrolled in the control group.Venous blood samples were taken from the peripheral vein and three SNPs in TLR4 gene,rs10759932,rs11536889 and rs2737190,were genotyped by matrix-assisted laser desorption ionization time of flight mass spectrometry analysis.Correction for Logistic regression analysis was made to eliminate the effects of sex,age,underlying diseases and operation methods.The correlation between genotypes of SNP and occurrence of sepsis,organ dysfunction,septic shock and death from sepsis was analyzed.The odds ratio (OR) and 95％ confidence interval (Cl) were calculated.Results Compared with the control group,there was a significant difference in genotype frequency ratios of rs10759932 (P ＜ 0.05),but there was no significant difference in genotype frequency ratios of the other two SNPs in sepsis group (P ＞ 0.05).There was correlation between rs10759932 and the occurrence of sepsis,and the variant allele (CT + CC genotypes) of rs10759932 increased the risk of sepsis (OR =1.86,95％ Cl 1.17-2.97,P ＜ 0.05).There was no correlation between the three SNPs and sepsis-related organ dysfunction,septic shock and death from sepsis (P ＞ 0.05).Conclusion There is correlation between the variant allele of TLR4 rs10759932 and the increase in risk of sepsis after surgery in Chinese patients of Han nationality.

Objective To observe the multi-slice spiral CT manifestations of cavernous transformation of the portal vein (CTPV) secondary to tumor emboli from hepatocellular carcinoma (HCC). Methods MSCT manifestations of 31 patients of HCC with tumor emboli-induced CTPV proved by operation and pathology were collected and the data were retrospectively analyzed. Results Tumor embolus was detected in both the trunk, left and right branches of PV in 23 patients, accompanied with superior mesenteric vein and/or splenic vein and inferior vena cava's tumor embolus in 4 and infiltration of gallbladder in 1 of 23 patients, as well as in the trunk and left branch in 1, and in the trunk and right branch of PV in 5 patients, accompanied with right hepatic vein and/or inferior vena cava's tumor embolus in 2 and in the portal trunk and superior mesenteric vein in 1, only in the right branch in 1 patient, respectively. Tumor emboli were isodense in plain CT scan, but enhanced with obvious degrees in arterial phase and filling defects in portal venous phase. There were collateral vessels around portal vein. Lateral branches around hilar bile duct, the open of venous plexus around fossa of gallbladder, lateral veins around gastric fundus and lesser curvature, lateral veins of lower part of esophagus and expansion of splenic vein were found in 31 (100%), 19 (61.29%), 21 (67.74%), 7 (22.58%) and 15 patients (48.38%), respectively. Conclusion Tumor emboli-induced CTPV from HCC has specific MSCT findings being helpful to the diagnosis.

Objective To summarize the methods and outcome of surgical treatment of thyriod carcinoma(TC).Methods The clinical data of 126 cases of TC admitted between 1990 to 2005 to our 2 hospitals was analyzed.Results Among the 126 cases,there were papillary carcinoma in 94 cases(74.5%),follicular carcinoma in 20 cases(15.9%),medullary carcinoma in 5 cases(4%),anaplastic carcinoma in 4 cases(3.2%),lymphoma in 2 cases(1.6%) and squamous cell carcinoma was in 1 case(0.8%).Thyroid microcarcinoma(TMC) was found in 56 of 126 cases and all of them were papillary carcinoma.(Seventy)-eight cases were followed up for more than 5 years after operation and 36 cases for 3 to 5 years,and all have good quality of life.All of the 4 cases with anaplastic carcinoma died in 3 to 6 months.Two cases with medullary carcinoma and 1 case with squamous cell carcinoma died from pulmonary metastases 1 year after operation.Conclusions For differentiated TC,surgical treatment is the ideal treatment.However,for(anaplastic) TC,operation is not to be recommended,the choice of treatment is radiotherapy.