Objective To evaluate the clinical efficacy of integration of traditional Chinese and western medicine (ITWM) or pure western medicine on the patients with immune thrombocytopenia (ITP). Methods Randomized controlled trials (RCTs) on ITWM treatment of ITP were searched in PubMed, EMBASE, Wanfang database, CBMDisc, CNKI and VIP. Quality of the RCTs was evaluated strictly, and statistical analysis was performed with Cochrane Collaboration’s RevMan5.1.7 software. Results Twenty-two trials involving 1527 patients were included. The results of Meta-analysis showed that the ITWM treatment of ITP significantly improved the total effective rate [RR=1.23, 95%CI (1.17, 1.29), P<0.000 01] compared with that of pure western medicine treatment. Funnel plot showed that publication bias was small. Meanwhile, peripheral platelet count and the number of megakaryocyte which can generate platelet in bone marrow increased, obvious advantage was showed in long-term effect, and adverse reactions were reduced with ITWM treatment in ITP patients. Conclusion The existed limited evidences suggest that ITWM treatment of ITP can significantly improve clinical efficacy. The quantity and quality of research literature were limited, and well-designed randomized double-blind controlled trials with large sample and multi-centers are required for a more reliable conclusion.

Objective To assess the interobserver reliability and intraobserver reproducibility of Neer classification system and its influencing factors.Methods The present study reviewed the series preoperative radiographs (including those of scapular anteroposterior view,scapular lateral view and modified Velpeau axillary view and an axial CT scan) of 40 patients who had been treated in our department from January 2010 to December 2010 for proximal humeral fractures.The radiographs were assessed by 12 individual observers on 2 separate occasions with an interval of 3 months at least Half of the observers (the professional group; n =6) had received a shoulder fellowship training and the other half (the control group; n =6) had not All the observers were asked to categorize the radiographs according to the Neer classification system of 16 types of fractures in a same process.The reliability and reproducibility of the system were assessed with the Kappa statistics.Comparisons of classification agreement were made between the professional group and the control group.We also evaluated the simplified Neer system of only 6 types of fractures with recombinant data.Results The interobserver reliability coefficients were 0.534 and 0.473 for the first and second assessments,with an intraobserver reproducibility coefficient of 0.669.The agreement level in the professional group was significantly higher than in the control group ( P ＜ 0.05).The interobserver reliability coefficients of the simplified Neer system were 0.581 and 0.502,with an intraobserver reproducibility coefficient of 0.680.Use of the modified Neer system did not elevate the agreement level beyond the moderate range.The classification was agreed on by all the observers in 17.5％ of the fractures during the first assessment and in 15.0％ during the second assessment.Conclusions Neer classification may have fair interobserver reliability and moderate intraobserver reproducibility.Experience of shoulder fellowship training is an important factor influencing the reliability of the Neer system.Simplification of the system may not help increase its reliability.

Objective To explore the rationality of clinical blood transfusion since the Ministry of Health enacted the The Technical Criterion of Clinic Blood Transfusion' in 2000. Methods Retrieved the literatures on the appraisal of rationality of clinic blood transfusion published in core journal between 2000 and 2010, and analyzed the rationality of clinical blood transfusion in recent 10 years. Results In 35 literatures entered, the proportion of appropriate blood transfusion of platelet was the highest compaved with the lowest proportion of plasma. the proportion of appropriate blood transfusion in operational department is higher than that in non-operational department. The primary reason of inappropriate blood transfusion is transfusion without indications. Conclusion The proportion of appropriate blood transfusion in china is low. The government should enhance the regulation of blood usage,and the public should he educated to realize the importarce of appropriote blood transfusion in order to promote it to develop healthily.

In clinical practice,regional portal hypertension is infrequent,but it is the only type which could be cured of portal hypertension.Pancreatic diseases are the chief pathogeny of regional portal hypertension,and the obstruction of spleen vein is the basic reason.The common clinical manifestation is isolatism varicose veins of pylorus.The golden standard of its iconography diagnosis is DSA,and the treatment should follow the individual principle.The splenectomy is the basic measure for them who have UGIB or hypersplenism.This is a review about recent advance in regional portal hypertension of etiology and classification,pathology and physiology,clinical manifestation,diagnosis,radiographic examination,cure,and so on.

Baby body plethysmography is a well-established technique of lung function determination,which is widely used to access the respiratory development and obstructive airway diseases by precisely measuring tidal breathing,functional residual capacity,and air way resistance.Babies who accept lung function measurements in the baby body plethysmography are under quiet state of spontaneous breathing without any subjective initiative,which results in multiplexed data acquisition,high precision and good repeatability.Clinical application of baby body plethysmography differs in different countries and areas,with the most intensive application in the German-speaking countries.In China,the clinical use of baby body plethysmography still remains in primary stage.Great progress has been achieved in its clinical use during the past 20 years,but there is still a lack of consensus on normal reference values or equations with which to interpret results,which has caused some trouble to diagnosis and identification of respiratory disease.In order to identify the nature and severity of airway disease,it is essential to understand the normal range of plethysmographic values that may occur in healthy infants of similar age,gender and body size.

Objective To investigate the effect of dopamine receptor in intestinal mucosal barrier function after brain injury in rats.Methods Twenty-four rats were allocated to control group,brain injury group,dopamine receptor group,and dopamine antagonist group according to the random number table,with 6 rats per group.Feeney' s weight-drop model was introduced to generate rat models of brain injury.Intestinal mucosal specimens were harvested at postoperative 7 days to evaluate intestinal mucosal morphology by HE staining,expressions of dopamine receptor D1 (DRD1) and dopamine receptor D2 (DRD2) by immunohistochemistry,and mRNA and protein expressions of DRD1 and DRD2 by real-time PCR and Western blot.Meantime,urinary samples were collected to measure lactulose to mannitol ratio (L/M) by high performance liquid chromatography (HPLC).Results Intestinal villus integrity was disrupted in brain injury group and dopamine receptor group when compared to control group,but it remained relatively intact in dopamine antagonist group.Ratio of L/M in brain injury group and dopamine receptor group was similar (0.192 ± 0.080 vs 0.183 ± 0.090,P ＞ 0.05),far higher than 0.037 ± 0.008 in control group (P ＜0.01),but it was reversed in dopamine antagonist group (0.071 ± 0.008,P ＜ 0.01).Real-time PCR showed DRD1 and DRD2 mRNAs expressed in brain injury group and dopamine receptor group were similar (0.764 ± 0.074 vs 0.718 ± 0.065,0.439 ± 0.051 vs 0.408 ± 0.090,P ＞ 0.05),far higher than 0.189 ± 0.008 and 0.076 ± 0.011 in control group (P ＜ 0.01),but both lowered in dopamine antagonist group (0.386 ± 0.071,0.270 ± 0.092,P ＜ 0.01).estern blot analysis showed DRD1 and DRD2 proteins in brain injury group and dopamine receptor group were similar,but both were far higher when compared to control group (P ＜ 0.01).Conclusion Impaired intestinal mucosal barrier may be relate to the up-regulated dopamine receptor in intestinal mucosa after brain injury in rats.

Objective To investigate the level of self-management behaviors and the quality of life with gastro esophageal reflux disease(GERD) patients,and analyze the correlation between self-management level and quality of life.Methods A total of 372 GERD patients were investigated by using Self-management Behavior Scale and Mos 36-item Short Form (SF-36) Health Survey.Results The level of self-management behaviors in GERD patients was relatively low.The total score of quality of life was (48.75±7.59) and the scores of the level of self-management behaviors was (5.13±0.59).Correlation analysis showed that there was positive correlation between quality of life and self-management behaviors(r=0.423,P＜0.01).Conclusion To promote the patients' health status,nursing staff should take measures to strengthen patient health education on the level of self-management behaviors for GERD patients.

[ABSTRACT]AIM:ToobservetheeffectofthesignalingpathwayofproteinkinaseC(PKC)-nuclearfactor-ery-throid 2-related factor 2 (Nrf2) on the expression of heme oxygenase-1 (HO-1) induced by cigarette smoke extract (CSE) in the rat airway epithelial cells .METHODS:After exposed to CSE , the airway epithelial cells of male SD rats were di-vided into control group , CSE3 group, RO318220 group, Nrf2 siRNA group and RO318220+Nrf2 siRNA group.The pro-tein levels of HO-1, Nrf2 and PKC were semi-quantified by Western blotting .The protein expression of HO-1 was assessed by immunocytochemistry .The mRNA expression of HO-1 was detected by reverse transcription-polymerase chain reaction ( RT-PCR) .Nrf2 protein location was observed by immunofluorescence staining .HO-1 activity was also determined .RE-SULTS:After exposure to CSE for 3 h, the Nrf2 protein was mainly located in the nucleus , and the expression level of Nrf2 protein in the nucleus was stronger than that in the control cells .CSE also significantly enhanced the levels of p-PKC protein, and HO-1 mRNA, protein and activity .Pretreatment with RO318220 significantly decreased the levels of PKC pro-tein, Nrf2 protein, and HO-1 mRNA, protein and activity.Meanwhile, Nrf2 protein significantly decreased , and the activ-ity, mRNA and protein levels of HO-1 were also significantly attenuated by pretreatment with siRNA to knock down Nrf2. Pretreatment with RO318220 and Nrf2 siRNA significantly decreased the PKC protein , Nrf2 protein, and HO-1 mRNA, protein and activity .CONCLUSION:CSE up-regulates the HO-1 expression through PKC-induced nuclear translocation of Nrf2 in the rat airway epithelial cells .

Objective To evaluate the clinical efficacy of neoadjuvant chemo radiotherapy combined with surgical treatment for advanced rectal cancer.Methods Fifty-one patients with advanced rectal cancer were randomly divided into treatment group and control group by random number table.In treatment group,26 cases received three-dimensional conformal radiotherapy synchronization XELOX chemotherapy for 2 cycles,then they received radical resection after 4-6 weeks.Twenty-five cases in control group received neoadjuvant chemotherapy with XELOX for 2 cycles,then received radical resection.Results The objective response rate in treatment group was 84.6％ (22/26),and in control group was 60.0％(15/25),there was significant difference between two groups (P =0.049).Radical resection in treatment group was 96.2％ (25/26),significantly higher than that in control group 76.0％ (19/25)(P =0.037).The sphincter preservation rate in treatment group was 61.5％ (16/26),and in control group was 20.0％ (5/25),there was significant difference between two groups (P =0.003).The pathologic complete response rate in treatment group was 26.9％ (7/26),significantly higher than that in control group 4.0％ (1/25)(P =0.024).The 1,2 and 3 year survival rate in treatment group were 88.0％(22/25),60.0％(15/25),32.0％(8/25),which were significantly higher than those in control group 62.5％ (15/24),29.2％ (7/24),8.3％ (2/24) (P =0.038,0.030,0.040).The 1,2,and 3 year recurrence rate in treatment group were 8.0％(2/25),20.0％(5/25),36.0％ (9/25),which were significantly lower than those in control group 33.3％ (8/24),44.8％(12/24),66.7％ (16/24) (P=0.028,0.027,0.032).Conclusion Neoadjuvant chemoradiotherapy can improve the rate of surgical resection,sphincter preservation and prolong survival of rectal cancer,it can be used as a kind of effective treatment for rectal cancer.

Objective To explore the relevance of the microRNA-192 (miR-192) levels and prognosis in patients with diabetic nephropathy (DN).Methods A total of 59 cases with duration of type 2 diabetes mellitus (T2DM) ≥10 years from January 2010 to July 2011 were retrospectively admitted.The miR-192 levels were determined after admission,and other relevant clinical data were collected.And the patients were followed-up for 24 months.According to the patient's prognosis,the patients were divided into DN group(20 cases) and non-DN group(39 cases),and the relevant information was analyzed in two groups.Results The miR-192 levels in DN group were lower than those in non-DN group[(4.47 ± 2.27) μ g/L vs.(7.28 ± 2.39) μ g/L],and there was significant difference (P ＜ 0.05).Multivariate Logistic regression analysis showed that hypertension history,smoking history,high glycosylated hemoglobin,low fasting C-peptide,low 24 h urine protein,low miR-192 level,high body mass index was the independent risk factors of prognosis of T2DM (P ＜ 0.05).The area under the receiver operating characteristic (ROC) curve was 0.697 in miR-192 levels individual predicting progression to DN stage,0.823 in six others without miR-192.After joining seven indicators forecast area under the curve increased significantly(0.856,95％ CI:0.832-0.904).The miR-192 levels 5.14 μ g/L was the best predictive value to the critical value of community,and the patients were divided into miR-192 ＜ 5.14 μ g/L group (28 cases) and miR-192 ≥ 5.14 μ g/L group (31 cases).The number of progression to DN within 24 months in miR-192 ＜ 5.14 μg/L group was more than that in miR-192 ≥5.14 μ g/L group (16/28 vs.4/31,P ＜ 0.05).Conclusions A reduced level of miR-192 is an independent risk factor that can lead to poor prognosis in patients with DN,and can predict adverse outcomes in patients with T2DM effectively.