The surgical treatment for portal hypertension (PHT) aims to control and prevent the gastroesophageal variceal bleeding.The choices of surgical timing and procedures are dependent on the liver reserve function.Except for Child-Pugh classification and model for end-stage liver disease scoring system,the future liver remrant and pre-albumin are the important evaluation indexes,meanwhile,the choice of surgical procedures would be dependent on portal hemodynamics that can reduce incidence of rebleeding of postoperative hepatic encephalopathy.Hepatic venous pressure gradient is the most important objective index forecasting bleeding risk and severity of PHT.

Pancreatic portal hypertension (PPH),which accounts for about 5％ of extrahepatic portal hypertension cases,is mainly caused by pancreatic tumor,chronic pancreatitis and pancreatic ductal lithiasis.The pathogenesis and pathological characteristics of PPH are attributed to anatomical structure between splenic vein and pancreas.It is different from cirrhotic portal hypertension,PPH patients may present with less esophageal and gastric fundus varices,but more significant gastric body varices.The portal vein radiography is recognized as the golden standard for PPH diagnosis.There are two types of treatment modalities for PPH,symptomatic treatment and pathogenesis-based treatment.In clinically,we should take careful consideration into portal hypertension and primary disease,aim to resolve causes and manage complication concurrently.

Objective To study the effect and mechanism of Feibi Decoction on pulmonary fibrosis.Methods SD rats were randomly divided into sham-operation group,model control group,Feibi Decoction large-close group,Feibi Decoction mid-dose group,Feibi Decoction samll-dose group and western medicine control group,each of 10 rats.Bleomycetin was used to copy rat's pulmonary fibrosis model.Feibi decoction was drenched to rats in large,medium and small dose of Chinese medicine groups.Prednisone was given to werstern medicine control group.The rats were executed 28 days later.The expression of p38 MAPK and transforming growth factor ?1(TGF-?1) was tested.Results In comparison with sham operation,Chinese medicine and western medicine groups,the expression of p38 MAPK and TGF-?1 in model control group increased significantly(P

Drinking ; physiology ; Humans

Objective To explore the clinical efficacy and safety of complex splenectomy.Methods The retrospective cohort study was adopted.The clinical data of 235 patients including 135 from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,67 from Shanghai Jiaotong University Affiliated First People's Hospital,26 from Shanghai Jiaotong University Affiliated Sixth People's Hospital,7 from 85 Hospital of PLA who underwent complex splenectomy from January 2005 to December 2015 were collected.All the patients received total splenectomy after splenic artery ligation.The observation indexes included:(1) surgical situations,(2) major complications including intraperitoneal hemorrhage,pulmonary complication,left subphrenic abscess and peritoneal effusion,(3) follow-up situations:portal vein (PV) complications (splenic venous thrombophlebitis,thrombosis of splenic vein and main portal vein thrombosis),survival of patients.The follow-up using outpatient examination and telephone interview was performed up to March 2016,and patients received regularly ultrasound reexamination,computed tomography (CT) rescan,routine blood retest and coagulation function.Measurement data with normal distribution were presented as-x ± s,and count data were analyzed using the chisquare test.Results (1) Surgical situations:of 235 patients,200 patients underwent secondary spleen pedicle severance and 35 patients underwent non-secondary spleen pedicle severance.Volume of intraoperative blood loss and duration of splenic resection were (268 ± 103) mL and (82 ± 29) minutes.(2) Major complications:of 31 patients with postoperative complications,intraperitoneal hemorrhage was detected in 12 patients,pulmonary complication in 17 patients,left subphrenic abscess in 3 patients and massive peritoneal effusion in 21 patients.Some patients were combined with multiple symptoms.The patients with above complications were cured after reoperations and non-operative treatments.(3) Follow-up situations:PV complications:splenic venous thrombophlebitis was detected in 16 patients,thrombosis of splenic vein in 17 patients,thrombosis of splenic vein combined with main portal vein thrombosis in 7 patients,and they were improved after the treatments of antiinflammation,anti-coagulation and thrombolysis.The thrombi rate after splenectomy was 32.4％ (12/37) in patients with schistosoma-related cirrhosis and 8.1％ (12/149) in patients with HBV-related cirrhosis,with a statistically significant difference (x2 =10.9,P ＜ 0.05).Survival of patients:of 235 patients,228 were followed up for (7.9 ± 4.2) years,with good survival.Conclusion Complex splenectomy is safe and effective,and the key procedure determining the safety of complex splenectomy includes careful preoperative evaluation,delicate surgical technique,proper splenic pedicle severance and peritoneal wounds.

Objective To investigate the clinical significance of silent mating-type information regulation 2 homologue 1 (SIRT1) in hepatocellular carcinoma (HCC).Method We analyzed p53 mutation by gene sequencing and activation of SIRT1 and AMP-actived protein kinase (AMPK) using western-blot in 252 patients with hepatitis B virus-positive HCC.Results A higher proportion of tissues with mutant p53 were demonstrated to harbor activated SIRT1 (64.8％ vs 31.8％ ; P ＜ 0.01).Activated SIRT1 predicted a longer relapse-free survival.On multivariate analysis,activated SIRT1 remained significant (OR:0.339,CI:0.160-0.720,P =0.005).Analysis of 252 paired specimens revealed a significant correlation between activated SIRT1 and activated AMPK in HCC tissues harboring mutant p53 (P =0.007).Conclusion SIRT1 exerted anti-carcinogenic effects through the AMPK pathway in HCC in the context of mutant p53.

ABSTRACT:Objective To investigate the regulation of adenovirus type 36 infection on precursor protein particles progranulin expression in Uygur obese patients.Methods Based on the diagnostic criteria of obesity,the samples were divided into obese group and non-obese group.Serum neutralization test was used to detect the antibody of Ad36.The progranulin mRNA expressions in abdominal omental and subcutaneous adipose tissues were detected by real-time quantitative PCR.ELISA method was used to determine serum progranulin protein levels. CD68 protein expression of macrophage was detected by immunohistochemistry. Results ① In the Uygur population of our study,compared with that in the non-obese group (38/1 1 7,32.5%),the number of obese patients (54/1 1 5,47.0%)infected with Ad36 was significantly higher than that in non-obese group (P <0.05 ).② Serum progranulin was significantly increased in the Ad36-infected obese group (408.45±1 56.92)than in non-obese group (326.1 1±1 58.60)(P <0.05).The mRNA expression of progranulin did not differ between the two groups.③ The macrophage infiltration was significantly higher in the Ad36-infected obese group (14 730.1 6 ± 2 227.39 )than in non-obese group (10 786.50 ± 2 772.80 )(P < 0.05 ).Conclusion Ad36 infection may be associated with the occurrence of obesity in Uygur population,and adenovirus type 36 infection may regulate the expression of serum progranulin at the protein level.

In order to study the the impact of cognitive difference between doctors and patients on doctor-patient relationship, five tertiary hospitals in city B were investigated with questionnaire and quantitative interviews, and the outcomes were analyzed with SPSS16. 0 software. Cognitive differences were found in the nature of the relationship, the main part of responsibility for the relationship, and principles for communication between the parties. By analyzing the causes of the difference and their impact on the relationship, it draw the conclusion that this cognitive difference found between the two parties functions as a key to the conflicts between doctors and patients. Return of health care back to non-profit nature, encouragement of patient-doctor communication and mutual understanding will be conducive to minimizing such a cognitive difference, and building a harmonious doctor-patient relationship.

Objective To investigate the relationship of the killer cell immunoglobulin-like receptor (KIR) gene polymorphism with Hashimoto′s thyroiditis(HT). Methods One hundred HT patients and 260 randomly matched healthy controls were enrolled to detect the KIR genotype. The genomic DNA were extracted, and 15 selected KIR genes, KIR2DL1-5, KIR3DL1-3, KIR2DS1-5, KIR3DS1 and pseudogene KIR2DP1, were determined by a polymerase chain reaction using sequence-specific primers (PCR-SSP). Results The frequency of KIR2DL5 gene was significantly lower of the patient group than that of the control group (0.200 vs 0.312, RR=0.64, P<0.01). Conclusion There may be an association between pathogenesis of HT and KIR2DL5 gene.

OBJECTIVETo investigate the possible differences in antimicrobial resistance of Escherichia coli isolated from different samples in children.

METHODSSix hundred and twenty-nine samples from urine, sputum, blood and secretion were collected from June 2004 to May 2009 for bacterial identification by VITEK-32 automatic system and antimicrobial susceptibility tests by Kirby-Bauer method. The drug resistance rate of Escherichia coli isolated from different samples was compared.

RESULTSTwo hundred and sixty strains of Escherichia coli were isolated , and 108 of which were from urine , 64 from sputum, 54 from secretion and 23 from blood. ESBLs were detected in 96 (36.9%) of the 260 isolates, AmpC enzymes in 32 (12.3%), and ESBLs+AmpC in 8 (3.1%). The ESBLs positive rate of Escherichia coli isolates from sputum was significantly higher than that from other samples (P<0.05). The antimicrobial resistance rate of Escherichia coli strains from different samples to amoxicillin/clavulanic acid, ticarcillin/clavulanic acid, piperacillin, cefotaxime, cefuroxime, cefepime, gentamicin, cotrimoxazole, and nitrofurantoin was different. The resistance rate of the strains from sputum samples was higher than that from the other samples (P<0.05).

CONCLUSIONSEscherichia coli isolated from different samples have different antimicrobial resistance rates in children, so the selection of antibiotics for infections confirmed by bacterial cultures from different samples should based on drug sensitivity results.

Adolescent ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; enzymology ; isolation & purification ; Female ; Humans ; Male ; beta-Lactamases ; analysis