Objective To explore the self perceived burden and its related factors in patients with chronic heart failure,and provide evidence for clinical nursing intervention.Method Using activity of daily living scale,general self-efficacy and selfperception burden interview scale to investigate the 298 cases of patients with chronic heart failure from our hospital.Results The self-perceived burden score was (24.84±6.74),and it was at the mild to moderate level,there were 77.52％ patients with mild to severe self-feeling burden.The self-efficacy score was (23.71 ±6.66),below the national norm (P＜0.01).The self-perceived burden was negatively correlated with self-efficacy (r=-0.365,P＜0.001).Factors including ages,gender,primary caregivers and self-efficacy were related with self-perceived burden in patients with chronic heart failure (all P＜0.05).Conclusions The self-perceived burden score of CHF patient is mild to moderate level,where age,gender,primary caregiver and self-efficiency are factors.Clinical staff should develop targeted interventions to reduce the burden on the level of self-feelings such patients,improving the quality of life of patients.

Objective To compare the diagnostic clinical significance between loop electrosurgical excision procedure (LEEP) and colposcopical biopsy for cervical intracpithelial neoplasia(CIN). Methods 130 cases of pa-tients diagnosed as CIN under colposcopical biopsy were treated by LEEP in court of gynecology clinic. The conven-tional pathologic diagnosis was recorded in all conization specimens. Results The coincidence rate between colpo-scopical biopsy and LEEP biopsy in CIN Ⅰ, CIN Ⅱ, CIN Ⅲ (not comprised carcinoma in situ) was 55.26%,66.10% ,78.79% respectively;The total coincidence rate was 66.15%. The accuracy of colposcopic biopsy for diag-nosing CINⅢ was higher than that for CIN Ⅰ and CIN Ⅱ,but there was no statistical difference. Conclusion Colpo-scopical biopsy for cervical lesions can be achieved for the frist time the results of pathology, have limitations. LEEP biopsy can compensate partially the deficiency of colposcopic biopsy. In a dear diagnosis of CIN, LEEP biopsy and colposcopical biopsy may complement each other, and achieve thcrpeutic effects.

Anatomic segmental hepatectomy,as an important part ofprecision surgery,has been accepted and widely applied as the promotion of precision hepatectomy.Anatomic segmental hepatectomy is superior to non-anatomical hepatectomy in clinical efficacy,application scope and operation techniques.There are many operation techniques developed by surgeons to accomplish segmental hepatectomy,and it is worthy for spreading in clinical practice.

Objective　To investigate factors influencing the incidence of massive bleeding caused by stress ulcer in severe acute pancreatiti s (SAP) and explore the effectiveness of measures for its prevention and treatme nt.　Methods　Clinical data of 121 pat ients with SAP were reviewed retrospectively in our center between 1993 and 1998 .The incidence of massive bleeding caused by stress ulcer in SAP, its affecting factors and the results of prevention and treatment were evaluated.　Results　The incidence of stress ulcer massive b leeding in SAP was 11.6% (14/121). The risk factors included the age of patient s, the severity of the disease, concomitant bile duct lithiasis obstruction, pan creatic abscess, pseudocyst and a history of surgical debridement and drainage. Five out of 6 patients treated conservatively died, while only 1 out of 8 treate d surgically died (P＜0.01).　Conclusion　Massive bleeding stress ulcer most often occurred in elderly SAP p atients, especially those of biliogenic, with pancreatic abscess and pseudocyst. Somatostain administration effectively decreases the incidence of bleeding. E mergency operation is mandatory when conservative measures fail to stop the bl eeding.

Objective To assess the feasibility of laparoscopic hepatic lobe procurement for living donor liver transplantation. Methods The technique included pneumoperitoneum with CO2,ports placement, porta hepatis dissection, laparoscopic ultrasound mapping, mobilization of the liver,and transection of the parenchyma into right and left lobes. The vascular structures were stapled and sectioned just prior to removal of the specimen. Results Hepatic lobectomies were successfully performed laparoscopically in 9 adult pigs. One pig was dead due to bleeding in IVC and following gas embolism during the parenchymal transection. The operative time was 208±25 min. The duration of warm ischemia was 8 ± 2. 3 min. The blood loss was 313 ± 75 mL. The vascular and biliary structures were preserved to allow for subsequent transplantation. Conclusion Laparoscopic living donor procurement for liver transplantation in a porcine model is safe and feasible.

BACKGROUND:Studies have shown that signaling pathway plays an important role in the pathogenesis of knee osteoarthritis. OBJECTIVE: To elaborate the experimental progress of signal transduction pathway in knee osteoarthritis METHODS: A computer-based retrieval of PubMed, CNKI, VIP and Wanfang databases was performed to find the relevant literatures concerning experimental studies of signaling pathway in knee osteoarthritis. Al data were primarily screened to exclude repeated and irrelevant articles. Articles about association between knee osteoarthritis and signal pathway were included.RESULTS AND CONCLUSION:A total of 51 articles were colected, including 20 in Chinese and 31 in English. It is concluded that the signal transduction pathway related to knee osteoarthritis is mainly concentrated in the two aspects: the proliferation of chondrocytes and the apoptosis of chondrocytes. The signal transduction pathways related to the proliferation of chondrocytes mainly include Notch signaling pathway and Wnt signaling pathway. SDF-1/CXCR4 signaling pathway, TLR4 signaling pathway, and MAPKs signaling pathway are associated with apoptosis in chondrocytes. Hippo-YAP signaling pathway and ERK1/2 signaling pathway have a double role in the regulation of proliferation and apoptosis of chondrocytes.

Objective To investigating the application of serum carbohydrate antigen 199(CA199) level increase in the patients with different characters of obstructive jaundice .Methods 21 patients with benign obstructive jaundice (benign group) and 24 pa‐tients with malignant obstructive jaundice (malignant group) were selected .The CA199 level in these two groups was higher than the reference value .Serum CA199 level was all higher than average value .The changes of serum CA199 level and direct bilirubin (DBIL) before and after treatment were dynamically monitored and their correlation was analyzed .Results There was no statisti‐cally significant difference in serum CA199 and DBIL levels before treatment between the benign group and the malignant group (P> 0 .05) .The serum CA199 and DBIL levels after treatment in the benign group were obviously decreased compared with before treatment ,the difference was statistically significant (P< 0 .05) ,however ,which in the malignant group had no statistical difference between before and after treatment (P > 0 .05) .Conclusion CA199 is not a marker of very high tumor specificity ,and could not serve as the sole marker for judging benign and malignant diseases .Dynamically monitoring the change of serum CA199 before and after treatment and its correlation with DBIL is conducive to differentiate between benign with malignant diseases .

Objective:To observe the complications caused by radiofrequency ablation (RFA) after RFA via the lumen of bile duct in hilum hepatis and the pathological progress of the tissue in ablation zones. Methods: Fourteen healthy dogs were randomly divided into 2 groups with 7 dogs each group. RFA by inserting a 13 mm non-insulated mono-electrode into the lumen of bile duct was performed under general anesthesia on 10 W power output, 4 min ablation duration in group Ⅰand on 5 W power output, 8 min ablation duration in group Ⅱ. After RFA, 2 dogs were sacrificed in 3 days and 1 dog in 9 days and 4 dogs in 14 days respectively in each group. The complications concerning RFA such as bile leakage, cholelithiasis, hepatic artery thrombosis, portal vein thrombosis, hepatic vein thrombosis1 and vena cava thrombosis were observed. Results: Portal vein thrombosis, hepatic vein thrombosis and vena cava thrombosis occurred in one dog. Cholelithisis occurred in one dos. No hepatic artery thrombosis occurred in all dogs. No bile leakage caused by RFA occurred in all dogs. Obvious necrosis of the mucosal and submucosal layers of the wall of bile duct and hepatic tissue in coagulation zones occurred in 3 days after RFA. The infiltration of inflammatory cells and partial fibrosis of the mucosal and submucosal layers of bile duct and hepatic tissue occurred in 9 days after RFA. Obvious fibrosis of the wall of bile duct and hepatic tissue occurred in 14 days after RFA. Conclusions: The complications caused by RFA occur seldom after RFA via the lumen of bile duct. The necrosis, the infiltration of inflammatory cells and gradual fibrosis of the mucosal and submucosal layers of bile duct and hepatic tissue occur in ablation zone.

Objective To evaluate the effect of different cold preservation time on liver regeneration after partial liver transplantation in rats,and study the role of IL-6/STAT3.Methods SD rats were divided into 3 groups:group Ⅰ underwent liver resection,group Ⅱ received partial liver transplantation after one-hour cold preservation and group Ⅲ received partial liver transplantation after 8-hour cold preservation.Radioimmunoassay was used to measure the levels of TNF-? and IL-6 in liver tissues.The protein expressions of PCNA and STAT3 were assessed by immunohistochemical staining in paraffin sections.The liver regeneration ratio and the expressions of the proliferative cell nuclear antigen(PCNA)and STAT3 were compared among three groups at 1,6,12,24,48,72 and 168 h after operation.Results The remnant liver in group Ⅰ and grafts in group Ⅱ grew rapidly;The regeneration ratio in group Ⅲ was significantly lower than that in group Ⅰ and group Ⅱ during postoperative day 2 to 3(P