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 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 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 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.

Objective To explore the imaging features on chest radiograph and CT in children with Influenza A H1N1 pneumonia. Methods The imaging data of chest radiograph and CT in six children with Influenza A H1N1 pneumonia confirmed by real-time RT-PCR assay was retrospectively analysis. All patients had chest radiograph at first examination and 4 of them re-examed. One children took CT. Results All cases showed thick lung markings with varied degrees of pulmonary infiltration and interstitial changes on chest radiograph. Among them, 3 cases showed bilateral pulmonary infiltration and 3 cases showed infiltration in left lung; enlarged hilar was observed in 3 cases. The imaging findings of the pneumonia changed quickly during the follow-up accompanied with the improvement of clinical symptoms. The only one chest CT examination showed bilateral infiltration, multiple ground-glass opacities,small subpleural nodulars, right pleural effusion and lymphadenopathy of lung hila and mediastinum. Conclusions Chest radiograph and CT revealed certain typical imaging features in the children with influenza A H1N1 pneumonia. However, the final diagnosis of influenza A H1N1 pneumonia still should be made based on epidemiology and laboratory examination.

nal abnormalities of pediatric heart diseases.

Objective To evaluate the role of multi-slice computed tomography (MSCT) in the diagnosis of pulmonary sequestration.Methods MSCT scans of 18 cases of pulmonary sequestration proved by surgery and pathology were reviewed.All cases underwent plain and contrast enhanced CT scanning,and retrospective reconstruction was made.Various reconstruction techniques in displaying the pulmonary sequestration and associated malformation were evaluated.Results Anomalous systemic arterial supply was discovered by transverse CT images in 12 cases.The reconstructed images using multiple methods showed the aberrant artery more clearly in all cases,including 6 cases in which the abnormalities were not confirmed by transverse CT.Drainage vein was revealed in 13 cases and lung heteroplasia with other malformation was demonstrated in 14 cases.Volume rendering (VR) reconstruction is the optimal choice for displaying the abnormal vessels and airway.Conclusion Enhanced MSCT with image post-processing can show the abnormal artery and vein of the pulmonary sequestration and the associated malformation,so it is the first choice in diagnosing pulmonary sequestration in pediatric population.