Objective To stady the diagnosis and management of traumatic chylous ascites.Methods Retrospective analysis was conducted on the clinical dada of 11 cases of traumatic chylous ascites resulting from various causes.ResultsThere were 5 cases of open abdominal injury,2 cases of closed abdominal injury and 4 cases of operative injury.Nine cases were treated with operation.According to the location and extent of injury,patients were respectively managed by operation of direct repair or ligation.Two cases had non-surgical treatment.All of the11 patients were cured and had satisfactory result at 0.5~3 years of follow-up.ConclusionsFor traumatic chylous ascites,if the injurg occurrence on cisterna chili,the best treatmeat is primary repair;if injury occarrence on the small intestinal trunks or lumbar trunk,which can be treated with ligation;while blunt injury and cases found after operation are mainly treated conservatively.

Objective:To retrospectively investigate the efficiency of Jinlong capsule combined with transarterial chemoemboli-zation for the treatment of advanced pancreatic carcinoma. Methods: Sixty advanced pancreatic carcinoma patients between January 2009 and May 2013 were randomly assigned into the experimental group (n=30, Jinlong capsule combined with transarterial chemoem-bolization) and the control group (n=30, transarterial chemoembolization). Both groups were subjected to superselective pancreas artery chemotherapy with GEMZAR at a dose of 1.0 g/m2. Results:The overall response rate (CR+PR) was 53.3%and the control rate was 70%(CR+PR+SD) (CR 0, PR 16, SD 5) in the experimental group, whereas those in the control group were 36.7%and 56.7%(CR 0, PR 11, SD 6), respectively. The short-term therapeutic efficacy was higher in the experimental group than in the control group (P<0.05). No significant difference in adverse reactions, including digestive reactions and myelosuppression, almost I-II degree, was observed be-tween the two groups (P>0.05). No significant difference in the Karnofsky performance status was observed between the two groups af-ter the treatment (P<0.05). The 24-month survival rate of the experimental group was 50.0%, whereas that of the control group was 33.3%(P<0.05). Conclusion:The application of Jinlong capsule combined with transarterial chemoembolization for the treatment of advanced pancreatic carcinoma showed good clinical effects. The patients also showed good tolerance to this treatment.

Cytochrome P-450 CYP2E1 ; metabolism ; Fatty Liver, Alcoholic ; enzymology ; pathology ; Liver ; enzymology

Objective To study the signal transduction mechanism of nicotine induced periodontal ligament fibroblasts (PDLFs) apoptosis. Methods This study used 1 μg/ml, 10μg/ml and 100μg/ml nicotine to intervene PDLFs cells for 24h separately. NF-κB, p53, I-κB and Caspase3 expression were detected. Results After Nicotine was done on PDLFs cells for 24h, the transcription of p53, and Caspase3,and the translation of Caspase 3 protein were increased, while NF-κB was decreased. At the same time, the transcription of NF-κB decreased gradually with the concentration of nicotine increased ( r = 0. 707, F =33. 705, P ＜0. 01 ), nevertheless, I-κB was reversed ( r =0. 964, F =374. 883, P ＜0. 01 ). p53 expression was increased gradually with the concentration of nicotine increased ( r =0. 957, F = 153. 377, P ＜0. 01).Both Caspase3 mRNA (r =0.935, F =318.371, P ＜0.01) and protein (r =0.677, F =8. 459, P ＜ 0. 05 )increased gradually. Conclusion Nicotine induced PDLFs apoptosis was mediated through NF-κB and p53 pathway.

Objective To explore the relationships between brain-derived neurotrophic factor gene G196A polymorphisms and psychopathology and the cognitive function in schizophrenic patients.Methods 224 patients and 220 normal controls were examined with polymerase chain reaction(PCR),denaturing polyacrylamide gel electrophoresis and silver staining to determine genotype and allele of G196A.Clinical symptoms were assessed with the Positive and Negative Symptom Scale (PANSS).Cognitive function was assessed with Wisconsin card sorting test (WCST) and Trail Making Test(CPT).To analyse the differences of the scores of Scale for the Assessment of Positive Symptoms(SAPS) and Scale for the Assessment of Negative Symptoms (SANS) among the patients with the genotype G/G,G/A and A/A.At the same time,the differences of the performance of WCST and CPT were analyzed.Results ①There were no significant differences of the genotypes G/G,G/A and A/A and allele G and A between patients and controls.②There were significant differences of the genotypes A/A between patients with Positive Symptoms and patients with Negative Symptoms (x2 =4.558,P ＜ 0.05).③There were no significant differences in the performances of complete categorizations and persistent wrong numbers of WCST and the performances of CPT among three groups of patients with genotype G/G,G/A and A/A (One-Way ANOVA,all P ＞ 0.05).Conclusion BDNF gene G196A polymorphisms are not associated with schizophrenia and the cognitive function but are associated with positive symptoms of schizophrenia.

Objective To Research the efficacy and side effects of intra-abdominal chemotherapy immune to the abdominal cavity after colorectal cancer liver metastasis and local recurrence.Methods 172 eases of colorectal cancer patients after radical operation were randomly divided into conventional regulation 86 cases of abdominal chemotherapy group(control group) and the immune abdominal chemotherapy group of 86 cases(observation group).The control group received 5-FU1.0,MMC8mg intraperitoneal chemotherapy The observation group at the grass-rcots level to add IL-2 50 million U.Results Observation group effective rate .was 70.9% higher than 55.8% (P ＜0.05) ;the obsenation gionp the three-year survival rate 83.7%,dlsease-free survival rate was 44.2% higher than the 62.8%,22.1% (P＜0.05) ;observation group three-year recurrence rate of 25.6% and 34.9% lower than the rate of liver metastases in the control group of 37.8%,48.9% (P＜0.05) ;two groups of gastrointestinal reaction,ⅠⅡ or degree of bone marrow suppression,liver function mildly abnormal ( elevated alanine amiuotransferase) had no difference.Conclusion For advanced colorectal cancer patients with early immune abdominal chemotherapy,the effective prevention and treatment of abdominal cavity and liver metastasis planting to improve the survival rate,side effects of light,fewer complications,the extension of survival,worthy of clinical application.

Objective To investigate the clinical manifestation, diagnosis, therapies and medical economics of cesarean scar pregnancy (CSP). Methods From Jan. 2005 to Dec. 2008, 96 patients with CSP treated in Obstetrics and Gynecology Hospital of Fudan University were studied retrospectively. Those cases were divided into 3 groups. Thirty-three patients were treated with methotrexate (MTX) 50 mg/m2 intravenously guttae in group A. Among that 18 cases were treated with MTX, after 5 - 10 days they underwent dilation and curettage of uterus; 15 cases were given by dilation and curettage first if the level of serum human chorionic gonadotrophin-β(β-hCG) descent less than 30% in every 48 hours for 3 times after curettage, then MTX (50 mg/m2) intravenously guttae. Sixty patients were treated with MTX 100 mg bilateral uterine artery injection and embolization in group B. After 2 days, they underwent curettage.Group C: 3 patients were treated with laparotomy lesion excision. The following clinical parameters were compared, including blood loss( M), lesion diameter (-x±s), blood β-hCG level (M)before treatment, the number of cases with myometrial thickness anterior to the CSP ≤3 mm, the resistant index (RI) ≤0. 5,expense(-x ± s), hospital days(-x ±s) in those 3 groups. The correlation of blood loss with lesion diameter and blood β-hCG level was studied. Results ( 1 ) Clinical manifestation: bleeding loss were 20 ml in MTX +curettage of group A, 10 ml in curettage + MTX of group A, 12 ml in group B and 200 ml in group C. The volume of bleeding loss in group C was significantly higher than those in group A or group B ( P ＜ 0. 01 ).The lesion diameter were ( 23 ± 15 ) mm in curettage + MTX of group A and ( 30 ± 14 ) mm of group B ,which were higher than ( 16 ± 8 ) mm of MTX + curettage of group A (P ＜ 0. 01 ). The lesion diameter of (52 ± 7 )mm in group C were significantly bigger than those in the other groups ( P ＜ 0. 01 ). The level of blood β-hCG levels were 21 592 U/L in MTX + curettage of group A, 979 U/L in curettage + MTX of group A,which reach statistical difference ( P ＜0. 05). The level of blood β-hCG levels were 11 312 U/L in group B and 101 U/L in group C. Among 28 cases with Rl≤0. 5,there was 8 cases in group A (24% ,8/33),18 cases in group B ( 30%, 18/60) and 2 cases in group C (2/3). Among 23 cases with myometrial thickness anterior to the CSP ≤ 3 mm, there was 21 cases in group B (35%, 21/60 ), which were significantly higher than 2 in group A (6%, 2/33 ) and none in group C ( P ＜ 0. 05 ). The expense were ( 5578 ± 3679) yuan in MTX + curettage of group A and (5346 ± 2765 ) yuan in curettage + MTX of group,which did not reach statistical difference (P＞0. 05). The expense were (7860 ±2104) yuan in group B,which were significantly higher than those in group A and (5004 ± 421 ) yuan in group C (P ＜ 0. 05 ). The hospital days were ( 15 ±8) days and ( 19 ± 14) days of group A, ( 16 ± 10) days in group B and ( 17 ±8)days in group C, there was no significant difference among those treatments ( P ＞ 0. 05 ). (2) Correlatin:there was positive correlation between bleeding loss and lesion diameter( r = 0. 31, P ＜ 0. 05 ) or blood β-hCG level ( r = 0. 35, P ＜ 0. 05). Conclusions MTX intravenously guttae, MTX uterine artery injection and embolization, and laparotomy lesion excision were all properly used in treatment of CSP. MTX uterine artery injection and embolization was recommended for those with big lesion, high β-hCG level, less myometrial thickness anterior to the CSP or plentiful blood supply of the lesion but the expense might be high.

Objective To study the effect of IGF-1 gene therapy and electric stimulation therapy on the rat models of postpartum stress urinary incontinence, and explore the ideal treatment for this disease.Methods 240 SD female rats were used to establish the model of postpartum stress urinary incontinence by water sac vaginal dilation.148 model rats were randomly selected from 185 successful models and divided into 5 groups:IGF-1 gene therapy, clenbuterol treatment, electric stimulation therapy, injection of empty vector plasmid, and untreated groups.Besides, 20 non-modeled rats were used as blank control group.Urodynamic test was performed, pelvic floor pubococcygeus muscle/muscle weight ratio was calculated, and serum biochemical indices (LDH, CK) were detected, and the morphological changes of pubococcygeus muscle fibers were observed by light microscopy at 1, 21, 42 and 63 days after treatment.Results At 21 days after treat-ment, the maximum bladder capacity, leak point pressure, the contractile force/muscle weight ratio in the IGF-1 group and electric stimulation treatment group were significantly better (P>0.05), and the differences between the IGF-1 group and electric stimulation group were not significant ( P>0.05 ) .Conclusions The effect of IGF-1 gene therapy and electric stimulation on the rat models of postpartum stress urinary incontinence is better than that in the drug therapy group and oth-er groups.

BACKGROUND:The distal tibia shaft fracture is prone to be comminuted after trauma due to the absence of muscle covering and the thin soft tissue, and intraoperative reduction and fixation are difficult. Clinical efficacy is closely related to the type of fracture, degree of soft tissue injury, choice of therapy and internal fixation. Internal fixation is the main treatment for the distal tibia shaft fracture, and a microinvasive, strong fixation is the focus of tibial fracture treatment although many methods for internal fixation are present. ＜br> OBJECTIVE:To explore clinical efficacy of the treatment of distal tibia shaft fracture using percutaneous locking compression plate, interlocking intramedul ary nail and open reduction with internal fixation. ＜br> METHODS:A total of 180 patients with distal tibia shaft fracture were randomized into three groups, receiving internal fixation treatment using percutaneous locking compression plate, interlocking intramedul ary nail or open reduction. Al patients were fol owed up for 12-24 months. The clinical outcomes of the treated patients in three ＜br> groups were compared through the observations of incision length, operation time, intraoperative fluoroscopy time, intraoperative blood loss, complications after fixation. ＜br> RESULTS AND CONCLUSION:After excluding the loss of fol ow-up, 56 cases receiving percutaneous locking compression plate, 52 cases receiving interlocking intramedul ary nail and 48 cases receiving open reduction were involved in the final analysis. The incision length and intraoperative blood loss in the groups of percutaneous locking compression plate and interlocking intramedul ary nail were significantly better than that of open reduction (P＜0.05). Intraoperative fluoroscopy time in the group of percutaneous locking compression plate was significantly longer than that in other two groups (P＜0.05). The operation time showed no significant differences among three groups. The rate of complications was 11%in the group of percutaneous locking compression plate, and 27%in the groups of interlocking intramedul ary nail and open reduction with internal fixation. Percutaneous locking compression plate is a good choice for the distal tibia shaft fracture due to smal injury, good biomechanical stability, and no influence on blood supply at fracture end;interlocking intramedul ary nail is also a useful technique due to simple operations. Open reduction with internal fixation should be chosen careful y due to great dissection, great influence on blood supply and high complication rate.

Based on summarizing the international experiences and reviewing the historical evolution and current situation of the physicians'compensation system of public hospitals in China,this paper clarified the existing problems of the current compensation system.Such problems namely included lack of security on the source of the physicians'compensation,low level of sunshine salary which caused thecompensatory mechanism,lack of scientific design of the salary structure and allocation,as well as other underlying causes.Drawing lessons from reform practices at home and abroad,the basic principles and reform directions were put forward,as well as 4 route selections,namely establishing an security investment system to guarantee a stable and higher level salary under the current compensation system, implementing a high level of flip-type annual compensation with locking the current salary into files, establishing an appropriate compensation system referring to an innovated evaluation system of physicians in public hospitals,and coordinating closely with public institution reforms to promote physicians' compensation system reform.