Objective To investigate the clinical efficacy of splenectomy combined with coronary-caval shunt in treatment of portal hypertension (PHT).Methods The retrospective descriptive study was conducted.The clinical data of 21 patients with PHT who underwent splenectomy combined with coronary-caval shunt at the First Affiliated Hospital of Xi'an Jiaotong University from January 2001 to December 2015 were collected.Observation indicators included (1) operation situations,changes of pre-and post-operative portal hemodynamics including operation time and volume of intraoperative blood loss,diameter and blood flow velocity of portal vein (PV),gastric coronary vein and superior mesenteric vein (SMV).(2) Clinical indexes in perioperative period (before operation,at postoperative 1 week and 1 month):① blood routine test:the counts of red blood cell (RBC),white blood cell (WBC) and platelet (PLT),② liver function:Child-Pugh score,alanine transaminase (ALT),total bilirubin (TBil),albumin (Alb),extended time of prothrombin time (PT) and international normalized ratio (INR).(3) Follow-up:postoperative 1-,3-,5-year complications [upper gastrointestinal re-bleeding,peritoneal effusion,hepatic encephalopathy,hepatic failure,portal vein thrombosis (PVT) and anastomotic stoma thrombosis].The follow-up using outpatient examination and telephone interview was regularly conducted once every 3 months within postoperative 1 year and once every 6 months after postoperative 1 year up to March 2016 or end of follow-up (death).Measurement data with normal distribution were presented as x ± s.The comparison of different time-point was analyzed by the repeated measures ANOVA and Student t test.Measurement data with sknewed distribution were presented as M (range).Results (1) Operation situations and changes of pre-and post-operative portal hemodynamics:21 patients underwent successful splenectomy combined with coronary-caval shunt,including 19 receiving splenic vein bypass combined with anastomosis of gastric coronary vein and inferior vena cava and 2 receiving anastomosis of gastric coronary vein and inferior vena cava.Operation time,volume of intraoperative blood loss were (187 ± 33)minutes and (233 ± 114)mL.Diameter and blood flow velocity of PV,gastric coronary vein and SMV were (1.39±0.20)cm,(0.66±0.15)cm,(0.74±0.32)cm,(11.2±3.4)cm/s,(6.6± 1.3)cm/s,(7.0 ±2.2)cm/s before operation and (1.36 ±0.22)cm,(0.42 ±0.11)cm,(0.81 ±0.23)cm,(10.4 ± 2.5) cm/s,(8.2 ± 2.5) cm/s,(6.9 ± 2.4) cm/s after operation,respectively,showing no statistically significant difference in the diameter and blood flow velocity of PV and SMV before and after operation (t =0.46,-0.81,0.87,0.14,P ＞ 0.05)and with statistically significant differences in the diameter and blood flow velocity of gastric coronary vein before and after operation (t =5.9 1,-2.60,P ＜ 0.05).(2) Clinical indexes in perioperative period:① routine blood test:the counts of RBC,WBC and PLT were (2.70 ± 0.50) × 1012/L,(2.6 ±2.3) × 109/L,(55 ±28) × 109/L before operation and (3.10 ±0.60) × 1012/L,(2.8 ±2.0) × 109/L,(248 ± 182) × 109/L at postoperative 1 week and (3.70 ±0.20) × 1012/L,(6.2 ± 1.9) × 109/L,(457 ± 184) × 109/L at postoperative 1 month,respectively,with statistically significant differences (F =31.91,11.03,30.74,P ＜ 0.05).There were statistically significant differences in the counts of RBC and PLT between 1 week postoperatively and before operation (t =-2.35,-4.81,P ＜ 0.05) and between 1 month postoperatively and 1 week postoperatively (t =-4.35,-5.65,-3.71,P ＜ 0.05).② Liver function:Child-Pugh score,ALT,TBil,Alb,extended time of PT and INR were 6.3 ± 1.2,(23 ± 17) U/L,(28 ± 18) μmol/L,(31.1 ± 6.8) g/L,(4.8 ±2.1) s,1.40 ± 0.20 before operation and 6.2 ± 0.9,(44 ± 24) U/L,(26 ± 11) μmol/L,(35.0 ± 7.4) g/L,(3.4 ± 2.0) s,1.30 ± 0.20 at postoperative 1 week and 6.0 ± 0.6,(36 ± 22) U/L,(23 ± 8) μmol/L,(34.2 ± 2.2) g/L,(3.7 ± 3.0) s,1.50 ± 0.30 at postoperative 1 month,respectively,showing no statistically significant difference (F =1.97,2.60,1.18,1.45,P ＞0.05).There were statistically significant differences in the ALT and extended time of PT (F =7.97,4.37,P ＜ 0.05) and in the ALT and extended time of PT between 1 week postoperatively and before operation (t =3.23,2.21,P ＜ 0.05).(3) Follow-up:21 patients were followed up for 3-168 months with a median time of 37 months.During follow-up,3 patients were dead.One,1,2 patients were complicated with upper gastrointestinal re-bleeding at postoperative 1,3,5 years and received hemostatic therapy under endoscopy,and then 2 were dead.Three,2 and 2 patients had peritoneal effusion and were improved by symptomatic treatment.One patient had hepatic encephalopathy and hepatic failure at postoperative 5 years and was dead after conservative treatment.PVT and anastomotic stoma thrombosis at postoperative 1,3,5 years were detected in 2,2,1 and 2,1,1 patients,with anticoagulant therapy,and 1 patient received vascular recanalization.Conclusion Coronary-caval shunt is a highly selective portosystemic shunt,it can significantly down regulate the regional pressure while ensure the normal blood flow of liver and decrease the rate of rebleeding,hepatic encephalopathy and thrombosis,meanwhile,it might be a potential therapy in management of PHT.

Objective: To analyze the characteristics of multislice spiral computed tomography (CT) for acute myocardial infarction. Methods: The anterior descending coronary arteries of 6 pigs were ligated at the 1/3 distal end to establish acute myocardial infarction model without reperfusion. Dual multislice spiral CT scanning was performed in all animals and the CT characteristics were analyzed. Results: Acute myocardial infarction model was successfully established in all 6 animals. Myocardial perfusion deficits were detected during early phase scanning; the area of deficits were significantly decreased during late phase scanning (13.52 ± 5.22% vs 9.07 ± 3.47% P = 0.004), with a mean decrease of 32.14%. CT value of different myocardial varied at different scanning times: the values of LV cavity decreased from (586 ± 111) HU to (294±53) HU (P = 0.001), that of the normal myocardial area decreased from (247±54) HU to (132±25) HU (P = 0.001); the values of the perfusion deficit regions were not significantly changed ([42 ± 14] HU vs [29 ± 23] HU, P = 0.289). During late phase scanning, CT value around residual perfusion deficit was higher than that of normal myocardium ([156±21] HU vs [132±25] HU, P = 0.004). Conclusion: The dual-phase MSCT characteristics of AMI include early perfusion deficits, late enhancement and residual perfusion deficits. Early phase scanning may overestimate the infarction area.

Objective To explore the effects of aerobic exercise training on the circulating miRNAs and their roles in cardio‐vascular adaption induced by aerobic exercise training .Methods Ten freshmen were enrolled .All subjects performed an 8 weeks swimming training .VO2 max and cardiovascular function were measured in acute exhaustive before and after the aerobic endurance training .The key circulating miRNs (miR‐133a ,miR‐21 ,miR‐146a ,miR‐199a ,miR‐15a and miR‐222) were measured at rest and im‐mediately following acute exhaustive exercise in competitive male freshmen before and after the aerobic training .Results Distinct patterns of c‐miRNA response to exercise were observed and adhere to 4 major profiles :after aerobic exercise training ,the levels of miR‐146a ,miR‐222 ,miR‐21 ,miR‐15a and miR‐199a at rest were significant higer than before training (P<0 .05) .The levels of miR‐146a and miR‐222 were up‐regulated by acute exercise before and after aerobic exercise training (P<0 .05) .Before the aerobic train‐ing ,acute exhaustive exercise increased miR‐21 and miR‐15a significantly(P<0 .05) ,however ,there was no difference between the miR‐21 and miR‐15a levels in acute exhaustive exercise and resting state after aerobic exercise training (P>0 .05) .There was no difference in the level of miR‐133a between resting state and acute exhaustive exercise before and after training (P>0 .05) .Further linear correlation analysis showed that the miR‐146a expression in plasma was significantly positively correlated with VO 2 max level (r=0 .842 ,P<0 .01) ,the change of miR‐222 expression in plasma before and after training was significantly positively correlated with EF (r=0 .920 ,P<0 .01) .Conclusion MiRNAs can be used as a marker to reflect the effect of training ,miR‐146a and miR‐222 play a role in physiological regulation of the cardiovascular function of aerobic exercise training in the body .

Objective To observe the relationship between short-term heart rate variability(HRV) and heart rate recovery (HRR) after exercise.Methods 495 patients (273 men),whose age ranged 19-85 years,were submitted to treadmill exercise tests and short-term HRV evaluations.The standard deviation of the normal-to-normal interval (SDNN),the square root of the mean squared differences of successive normal-to-normal intervals (RMSSD),the number of interval differences of successive normal-to-normal intervals greater than 50 ms (NN50 count),the proportion derived by dividing NN50 count by the total number of normal-to-normal intervals (pNN50) and frequency(lowfrequency power,high-frequency power,total power) domains were observed.Results Among 495 patients,106 patients(68 men) were elderly(age≥65 years).Male gender and hypertension were significantly higher in elderly patients.The young patients had higher HRR after exercise.HRR at 4min (54 ± 13) vs (60 ± 12) beats/min,P =0.003 was the most significant predictor for positive exercise test result.In the young group,both time domain measures (SDNN:correlation coefficient 0.34,P ＜ 0.001 ; RMSSD:correlation coefficient 0.37,P ＜ 0.001) and frequency domain measures (LF:correlation coefficient 0.21,P ＜ 0.001 ; HF:correlation coefficient 0.13,P =0.01 ; total power:correlation coefficient 0.22,P ＜ 0.001) were significantly associated with HRR at 4min.Conclusion HRR at 4min was significantly associated with short-term HRV of time and frequency domains in young individuals,but not elderly ones,who received treadmill exercise test.

[Objective]To investigate the effect of surgical treatment of scapular fractures through posterior approach.[Method]From May 2000 to November 2007,14 patients(10 females,4 males;mean age 34.6 years)with scapular fractures were treated by open reduction and internal fixation through a posterior approach.Eight patients were injurred in traffic accidents,3 due to falling,2 by direct violence and 1 due to cut.There were eleven patients with close fractures and 3 with open fractures.According to Hardegger classification system,there were 8 cases of scapular body fracture,9 of scapular spine fracture,6 of scapular acromion,10 of scapular neck fracture,6 of glenoid rim fracture and 4 of glenoid fossa fracture.[Result]Fourteen patients were followed up,with a mean follow up time of 18 months.According to Rowe score system,10 patients showed an excellent result,2 showed a good result,the other two showed a fair result.[Conclusion]The posterior approach for fixing scapular fractures has advantages of wide exposure,safety,easy operation,and reliable effect.It is a choice of operation for most types of scapular fractures,especially for scapular body fracture,spina scapular fracture and scapular multiposition fracture.

Hyaluronic acid(HA)is a linear polysaccharide chain composed of alternating ?-1,4-glucuronic acid(GlcA)and ?-1,3-N-acetylglucosamine(GlcNAc)moieties.Construction of engineering strain has become the prevailing strategy for increasing yield and improving its quality,especially the molecular weight.Here the molecular mechanism of HA biosynthesis in Streptococcus strains was reviewed,involving fermentation strains,operon structure,crucial enzyme and construction of engineering strains.In addition,the prevalent problems in HA fermentation production were also discussed and the protocols were tentatively put forward for the upcoming research and industrial production.

Objective To detect the clinical features and prognostic factors of nasal cavity malignancy with breast metastasis.Methods 846 Patients with nasal cavity malignancy from January 1999 to December 2011 were enrolled,the clinical and pathological features,clinical diagnostic methods and prognostic factors for breast metastasis patients were analyzed.Results Six female cases (median age 25) were diagnosed with breast metastasis,including 3 rhabdomyosarcoma and 3 olfactory neuroblastoma; consisting 0.7％ of the total 846 cases of primary nasal malignancy group.The metastasis were more likely to be multiple breast lesions with/without metastasis in other site.For the primary tumor,five patients received 66-72 Gy/30-33f of radical radiotherapy,one patient with rest rhabdomyosarcoma received 58 Gy of palliative radiation since breast metastasis was found after 14 Gy of radiation and breast mass resection were performed right after.For the breast metastasis,five of 6 patients received breast surgery,one patients with olfactory neuroblastoma received 6 cycles cyclophosphamide + adriamycin + vincristine chemotherapy.Median survival was 12.7 months.Conclusions For nasal cavity malignancy,breast metastasis more likely occur in younger female patients.Ultrasound may provide useful information in evaluating breast metastasis.Cases combined with metastasis except breast have unfavorable prognosis.

Objective To introduce the improvement of the flap from the dorsal site of the index in the application of treatment in the thumb web contracture. Methods Apply improved first dorsal metacarpal flap for 111 cases of patients of the thumb web contracture releasing. The original island or tongue-shaped flaps was modified to be the local flap transfer to the thumb web. Surgical method simplified. Before thumb web contracture was released, the flap was taken from ulnar aspect to radial aspect on the dorsum of the index. The flap was transferred to cover the soft tissue defect on the first web space following the contracture releasing. Flap donor area was closed by split-thickness skin graft. Results One hundred and eleven cases of flaps survived. After the 3-18 months (mean follow-up of 8.5 months), the local appearance, thumb function recovered well for 94.6 percent. Conclusion Improved first dorsal metacarpal flap is effective methods in thumb web contracture releasing.

Objective To evaluate safety and efficacy of a fractional microneedle radiofrequency device in the treatment of axillary osmidrosis.Methods A total of 24 patients with moderate to severe axillary osmidrosis were enrolled from Department of Dermatology of Peking Union Medical College Hospital between June 2015 and June 2016,and treated with the Body TiteTM fractional microneedle radiofrequency device for 1 session.Visual analogue scale (VAS) was used to evaluate the intensity of axillary odor in patients,36-item short-form health survey (SF-36) to assess health-related quality of life (HRQoL),and axillary skin tissues were resected for histopathological examination before and after the treatment.Results VAS showed that 22 of 24 patients achieved persistent remission for more than 12 weeks,and rates of decrease in odor score ranged from 50％ to 100％.However,1 patient experienced recurrence at 12 weeks after the treatment,and another 1 patient did not achieve clinical remission.SF-36 revealed that scores of social functioning (SF),role-emotional (RE) and mental health (MH) scales were all significantly increased after the treatment [M (P0-P100):100.00 (62.00-112.50),100.00 (33.30-110.00),68.00 (48.00-80.00),respectively] compared with those before the treatment [77.50 (62.50-100.00),66.67 (33.30-100.00),55.00 (48.88-72.00),respectively,all P ＜ 0.05].Histopathological examination showed obvious degeneration and necrosis of sweat gland cells in 22 cases,and epidermal damages in 2 patients after the treatment.Unilateral upper-limb pain occurred in 1 case,and small-area burn-like skin changes were observed in 2 cases after the treatment.The postoperative recovery time ranged from 7 to 14 days.Conclusion The fractional microneedle radiofrequency device has shown high clinical response rate,good safety,and favorable application prospects in the treatment of axillary osmidrosis.

Background The rat model of N-methyl-N-nitrosourea (MNU)-induced photoreceptor cell apoptosis is often used to study retinal degeneration.But the changes in the gene expression patterm in retinal degeneration in rats have not been reported.Objective This study was undertaken to investigate regulation of gene expression in the retina of MNU-induced retinal degeneration in rats by performing microarray analysis of retinal RNA.Methods Fifty 6-week-old SD rats were numbered and randomized into the normal group and the model group.The retinal degeneration model was established by a single hypodermic injection of 40 mg/kg of MNU,and the rats in the normal group received equivalent volume of physiological saline in the same way.The rats were sacrificed 12 hours or 24 hours after injection.Retinal sections from the right eyes were prepared for the measurement of the retinal thickness by histopathological examination,and retinas from the left eyes were used to confirm the differential gene expression as detected by microarray (normal group and 12 hours model group).Genes exhibiting changes in expression by ≥2.0 folds were further confirmed using real-time PCR.Results The whole thickness of the retina declined in the rats from the 24 hours model group compared to the normal group and 12 hours model group (t =9.926,P=0.002;t=2.736,P=0.028).The thickness of the outer nuclear layer was (26.58±2.90) μm in the 24 hours model group,showing a significant decrease in comparison with (38.11 ± 1.01) μm in the normal group and (35.07t3.03) μm in the 12 hours model group (t=6.028,P=0.009;t=6.839,P=0.006).However,there was no significant difference in retinal thickness between the normal group and the 12 hours model group (whole thickness:t=1.541,P=0.324;outer nuclear layer thickness:t=2.040,P=0.134).Microarray analysis of the rat genes showed that out of 17 000 genes,142 genes involved in biological process and 94 genes involved in molecular functions were differentially expressed,where most of them participate in the mitogen activated protein kinase signaling pathway,Tolllike receptor signaling pathway and apoptosis pathway.Real-time PCR analysis demonstrated that the expression of CCL2,IL-1b,CCL3,c-fos,c-myc,p53 and MMP3 were consistently up-regulated,conforming with the results from microarray analysis.Conclusions The changes in gene expression pattern appear in the early stage of MNUinduced retinal degeneration.These microarray results provided clues to understanding the molecular pathways underlying photoreceptor degeneration and indicating the directions for future studies.