Objective To evaluate the performance of aspartate aminotransferase to platelet ratio index (APRI) in the assessment of fibrosis in chronic hepatitis B virus (HBV) infection patients with transaminase level less than two times of upper limits of normal (ULN),and to analyze the clinical utility in antiviral therapy.Methods A total of 349 clinically diagnosed chronic HBV infection with alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level less than 2 × ULN were enrolled.Liver biopsy and routine laboratory tests were performed to calculate the ratio of AST to platelet (PLT),namely the APRI,and to compare the relationship between liver fibrosis and APRI.Diagnostic performance of APRI model was assessed by using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) analysis.Correlation between APRI and liver fibrosis was determined by Spearman rank correlation analysis.Results The AUC of APRI≥0.273 for significant liver fibrosis was 0.641 with sensitivity of 48.3％,specificity of 75.7％ and positive predictive value of 73.9％.The AUC of APRI≥0.311 for cirrhosis was 0.771 with sensitivity of 68.6％,specificity of 76.8％,and negative predictive value of 93.5％.In patients with HBV DNA level ranging from 1 × 103 to 1 × 105 copy/mL,the optimal cut-off value of APRI was 0.179 for significant fibrosis (P＝0.00) and 0.283 for cirrhosis (P=0.00).By Spearman rank correlation analysis,APRI was positively correlated with histologic stages of fibrosis (r=0.370,P＜0.01).Conclusions APRI can be utilized to assess liver fibrosis in HBV infection with ALT and AST level less than 2 × ULN.APRI≥0.273 (pathologic stages of fibrosis ≥S2) has obvious hepatic fibrosis,which may help physician to select the optimal time for antiviral therapy.APRI may serve as a potential tool for assessing liver fibrosis according to HBV DNA levels.

Objective: To study the influence and curative effect of carvedilol on serum matrix metalloproteinase -2, 9 and 10 (MMP-2, 9 and 10) in the patients with chronic congestive heart failure (CHF). Methods:Totally 76 patients with CHF were select-ed and randomly divided into the observation group and the control group. All the patients were given routine medical treatment, inclu-ding cardiotonic treatment ( digoxin) , diuresis ( thiadiazide) , vascular dilation ( nitrate ester) and so on. The patients in the observa-tion group were additionally given carvedilol for 6 months. The changes of serum MMP-2, 9 and 10 levels in the patients before the treatment and 6 months after the medical treatment were observed, and the curative effect and safety were studied as well. Results:Af-ter the 6-month medical treatment, the serum MMP-2, 9 and 10 levels in all the patients were obviously declined(P<0. 05), and the declining rates in the observation group were much higher than those in the control group(P<0. 05). Meanwhile, the total clinical effi-ciency of the observation group was 94. 74%, which was higher than that of the control group (78. 95%) (P<0. 05). Conclusion:Carvedilol has favorable curative effect and safety in the treatment of CIF, and the underlying mechanism may be relative to the de-crease of serum MMP-2, 9 and 10 levels.

[Objective] To discuss the cure effect of acupoints application combined with TCM decoctions and auricular point buried-bean on pernicious vomiting. [Method] Choose 65 such cases from April 2011 to March 2012 as control group and another 65 from Nov. 2011 to Sep. 2013 as treatment group. The control one take oral y TCM decoction combined with auricular point buried-bean, the treatment one added with TCM acupoints applica-tion;observe the result after 1 course. [Result] In treatment group, 46 cases were cured, 18 better, 1 was not cured, the total effective rate 98.5%;in con-trol one, they were respectively 40,11,14 and 78.4%; the comparison of them had difference of statistical meaning.[Conclusion] The acupoint application combined with TCM decoction and auricular point buried-bean has obvious cure effect on pernicious vomiting.

Objective To analyze the X ray findings of enema unreduced (including 4 perforations ) intussusception so as to improve the knowledge about the difficulty of reduction by air enema or the risk of perforation. Methods Of the 552 cases, 506 cases were successfully reduced by air enema. The range of air pressure was 6.67 to 14.67 kPa(60～110 mm Hg). Forty six unreduced cases were cured by operation. The films were taken before and during the reduction period. X ray findings were analyzed compared with that of the operative pathology. Results (1)Abdominal plain films showed total obstruction in 26 cases and asctis in 4 cases; (2) Air enema showed big and lobular masses in 36 cases and the location of masses in distal part of colon in 22 cases; (3)Operation pathology: ileoilecolic intussusception in 35 cases, 15 cases with intestinal necrosis (including 4 perforation cases). In 3 cases, perforations were in the intussusceptum,the other in the intussuscipiens. Conclusion 92% of intussusceptions can be reducted by pressure of air enema. Complex intussusception, with intestinal necrosis and primary intussusceptum, are difficult to reduce, and these patients ought to be operated on time.

Objective:To explore the humanistic care model and its effects in emergency nursing.Methods:Through literature research,analysis process and interviews,we constructed the humanistic care model,formulated corresponding humanistic care nursing measures,and implemented them in clinical practice.The humanistic care satisfaction questionnaire was used to evaluate the effectiveness.Results:The satisfaction rate of humanistic care was improved,and the difference was statistically significant (P ＜ 0.001).Conclusion:The construction of humanistic care model can significantly improve the satisfaction of emergency patients,and the standardized process should be established in the implementation of humanistic care.

Objective To study on the ultrastructural characteristic of segments of photoreceptors from neonatal retinas for supporting donor retina choice of retinal transplantation. Methods Photoreceptors from neonatal calf and adult calf were analysed by scanning electron microscopy and transmission electron microscopy. Results Segments of photoreceptors from neonatal calf appeared the mushroom pattern, in which, distal end of outer segment which was ball shaped formed the head with mushrooms appea rance, and the inner segments along with some of outer segments formed the body with mushrooms appea rance. Within the outer segment, plasma membranes of adjacent evaginations form a disk subsequently. The array of most disks were vertical to the entire length of segments, but some were parallel and slope to. Owing to the incomplete formation, some rim of disk near distal end of outer segment revealed step shaped appearance. The distal end of outer segment displays some processes consisted of membranous discs, much vesicular material and mitochondria, much rough endoplasmic reticulum (RER) and numerous polysomes. Segments of photoreceptor connected with outer nuclear layer via the external limiting membrane. Conclusion The typical morphological structures of outer segments suggest the immature and strong gowth ability of photoreceptors of the retina of neonatal calf, and therefore the competence for donor material of retinal transplantation.

Objective To study the value of chest radiograph and thin-section computed tomography (CT) in diagnosis bronchiolitis obliterans in children, and to determine clinical view of obliterative bronchilitis in children. Methods We identified 12 infants, 10 boys, and 2 girls (age range, 5 month to 11 years) with clinical confirmation of bronchiolitis obliterans. Three cases were after Steven-Johnson syndrome, 8 were post-infection(2 adenovirus, 2 measles and 1 Pseudomonas aeruginosa infection, 3 cases were unknown etiology infection) ; The symptoms lasted for at least 6 weeks. One case had lung ventilation nuclear scan. We evaluated individual bronchscopy, pulmonary function test, chest radiograph and thin-section CT features and their characteristic appearance. Results All cases had typical clinical characteristics and pulmonary function testing results that were consistent with nonreversible small airways obstruction. One case had lung ventilation nuclear scan illustrated absent and reduced ventilation of the right lower lobe. Nine cases who underwent bronchoscopy were chronic endobronchial inflammation. Three children had transbronchial biopsy and 1 patient who underwent open pulmonary biopsies were uncertain of histological diagnosis. Chest radiography showed hyperinflation in 8 cases; peribronchial thickening in 6 cases; consolidation/atelectasia in 6 cases; unilateral hyperlucency of a small/normal-sized lung in 4 cases. Thin-section CT/HRCT features included: mosaic perfusion pattern, decreased lung attenuation in 11 cases, pulmonary vascular attenuation in 10 cases; bronchial dilatation in 7 cases; bronchial wall thickening in 9 cases; unilateral hyperlucency of a small/normal-sized lung in 5 cases; consolidation in 6 cases; nodular in 3 cases; mucoid impaction in 5 cases. Conclusions In our study, correct diagnoses of bronchiolitis obliterans in children were made more special with thin-section CT than with chest radiographs. The diagnosis of BO in children can be based on the characteristic clinical situation, pulmonary function, indicating minimally reversible airways obstruction and characteristic thin-section CT findings.

Objective To investigate the effect of bFGF and MSCs autografting on expression of PCNA and Ⅷ-R Ag of porcine skin defect wound. Methods Six male minipigs were used to produce 48 full-thickness skin wounds, each wound area about 2.54 cm~ 2 on both sides of the back (8 wounds per pig). These 48 wounds were randomly treated with bFGF, MSCs, bFGF+MSCs, and normal saline (12 wounds for each treatment). The tissue from the wounds was harvested on day 3, 7, 14 after surgery, then used for HE staining and immunohistochemical staining for proliferating cell nuclear antigen (PCNA) and factor Ⅷ related antigen (Ⅷ-R Ag). Results Granulation tissue was presented in all groups on day 3 and 7 after wound, most abundant in the wounds treated with bFGF+MSCs, as well as blood capillary formation. PCNA expression increased after skin injury, reached the peak on day 7, most in the granulation tissue, and lasted to day 14, then began to decrease. On day 3, 7, 14 after skin injury, PCNA expression was the most highest in the wounds treated with bFGF+MSCs. Ⅷ-R Ag-positive cells in the wounds treated with bFGF+MSCs were significantly more than that of the other three treatments (P

Objective To evaluate our experience in the diagnosis and surgical management of papillary thyroid microcarcinoma(PTMC). Methods Clinical data of 42 PTMC cases were retrospectively analyzed. Results Twenty-five clinically nonpalpable PTMC were detected by high resohition thyroid uhrasonography preoperatively.The diagnosis of PTMC was established intraoperatively by frozen biopsy in 14 out of 19 cases undergoing this procedure.Of the 42 patients,30 underwent a lobectomy,and in 11 out of 30 patients supplemented level Ⅵ lymph node dissection was performed.None of these patients had recurrence during follow-up.The recurrence in three patients with multffocal lesions and undergoing incomplete resection were observed at follow.up.The mulifocality of PTMC and ipsilateral residual volume of the thyroid were two predicting factors that significantly influence the postoperative recurrence(P＜0.05,P＜0.01 respectively)in patients with PTMC. Candus-ions PTMC is usually occult and eludes correct preoperative diagnosis.Most PTMC are clinically nonpalpable and may be detected by hish resolution thyroid ultrasonography and diagnosed by frozen section during the operation.Surgery is the most important treatment of PTMC.Lobectomy plus level Ⅵ lymph node dissection is the therapy of choice for PTMC patients at the stage of cN0.

Objective To investigate the effect of plasmid pEGFP- hepatocyte growth factor (HGF)-C1 on rat acute ischemia of hindlimb.Methods The eukaryotic expressed plasmid pEGFPHGF-C1 carrying human HGF cDNA was constructed.The transfection efficiency and the expression level of HGF were evaluated by transfecting pEGFP-HGF-C1 into primary rat skeletal muscle cells.Ligation-induced ischemia of femoral artery of one hindlimb in Wistar rats was performed.The plasmids (200 μg/500 μl) were injected once directly into the ischemic limb muscle (5 sites around ligation position) immediately after ligation.HGF expression was detected in the muscle tissue of rats on days 3,6 and 9 by immunochemical stain and Western blot.At day 24,the muscles were removed and stained with CD31 to assess histologically the capillary formation.Results The primary rat skeletal muscle cells could be transfected 0efficiently with pEGFP-HGF-C1 using LipofectamineTM2000 (0.8％),and secreted HGF which peak concentration was (5402.0±227.9) ng/L at 4 d.HGF expression was detected clearly in muscle tissue on days 3,6,9 in pEGFP-HGF-C1 groups.Western blot semi-quantitied analysis showed the levels of HGF expression were higher than control groups on days 3,6,9(P＜0.05).A significant increase in capillary density was found in rats transfected with human HGF(10.81±2.35) as compared with sham group (6.11±0.90) and control group (5.45±0.90) at 24 d(P＜0.01).Conclusions Intramuscular injection of naked human HGF plasmid may induce therapeutic angiogenesis in rat ischemic hindlimb models,as potential therapy for peripheral arterial disease.