ObjectiveTo study the diagnostic value of serum type IV collagen(IV-C) in hepatic fibrosis. MethodsSerum IV-C levels were detected by using radioimmunoassay(RIA) and were compared with serum type Ⅲ procollagen(PCⅢ ) levels in normal controls(NC) and patients with chronic liver diseases. ResultsSerum IV-C and PCⅢ levels in patients with chronic liver diseases were all much higher than those in NC(P < 0.01, totally). Serum IV-C level in severe chronic hepa titis(CH) group was significantly higher than those in mild and median CH groups (P<0.01 total ly), and that in active liver cirrhosis(LC) group was significantly higher than that in static LC group (P＜0.05). There were significant positive correlation between serum IV-C level and serum PcⅢ level both in CH group and in LC group ( in CH γ=0.7023, in LC γ=0. 5878, P＜0. 001).Conclusion Serum IV-C level could reflect the activity of hepatic fibrogenesis.

Objective To evaluate the effect of the early goal-directed therapy (EGDT) on mortality in patients with septic shock, and to analyze the risk factors of mortality.Methods A retrospective controlled study was conducted.Complete clinical data of patients with septic shock admitted to emergency intensive care unit (EICU) of Sichuan Provincial People's Hospital from May 1994 to December 2014 were recorded and analyzed.According to the International Guidelines for Management of Severe Sepsis and Septic Shock (SSC) with the time of promulgation as dividing point, the patients were divided into two groups as before and after the publication of the guideline, i.e.early group (from May 1994 to April 2004) and late group (from May 2004 to December 2014).The patients of the late group were subdivided into 6-hour and 24-hour reaching standard groups and non-reaching standard group according to the time of reaching standard of EGDT.All patients were divided into death group and survival group according to the 28-day survival.The patients in early group were not treated according to EGDT guidance, so only age, the case history of chronic disease, the main site of infection, organ dysfunction, vital signs, urine output, the amount of fluid for resuscitation, blood routine, blood gas analysis, time for starting antibiotics treatment, the use of vasoactive drugs and hormone, etc.were recorded.The central venous pressure (CVP), central venous oxygen saturation (ScvO2), blood lactate (Lac), and the monitor of other parameters of patients in late group were consummated late.The relationship of EGDT compliance standard time and tissue perfusion index recovery time between the two groups of patients was observed.The risk factor for mortality was analyzed by multiple factors logistic regression.Results ① 134 patients were included,and the overall 28-day mortality was 49.25％.② The 6-hour EGDT compliance rate of early group was 0 (0/58),and it was 28.95％ (22/76) in late group (x2 =20.087, P =0.000).Compared with the early group, the 6-hour urine volume in the late group was significantly increased (mL·h-1·kg-1: 1.72± 1.04 vs.0.89±0.24, t =11.950, P =0.001),6-hour mean arterial pressure (MAP, mmHg, 1 mmHg =0.133 kPa) was elevated (64.24±3.90 vs.56.21 ±5.95, t =6.444, P =0.012), the use of antibiotics within 1 hour was increased (76.32％ vs.48.28％, x2 =11.250, P =0.001), the use of vasocative drugs (21.05％ vs.89.66％, x 2 =61.942, P =0.000) and hormone (8.57％ vs.34.48％, x 2 =14.871,P =0.000) were lowered, and the 28-day mortality rate was lowered significantly [34.21％ (26/76) vs.68.96％ (40/58),x2 =15.897, P =0.000].The difference was not statistically significant in the total recovery of liquid volume between late group and early group (mL: 1 856.31±805.81 vs.1 903.1 ± 897.11, t =0.101, P =0.752).③ In all patients, it was shown by single factor analysis that the age, infection sites, altered mental status at admission, white blood cell (WBC) before treatment, 6-hour urine output after treatment, the number of organ with failure, the use of antibiotics within 1 hour, and incidence of acute renal injury (AKI) or acute lung injury/acute respiratory distress syndrome (ALI/ARDS) within 24 hours were risk factors of 28-day death (P ＜ 0.05 or P ＜ 0.01).In the late group, it was shown by single factor analysis that the age, the case history of chronic disease, infection sites, WBC, pH value, Lac, and ScvO2 before treatment, 6-hour urine output after treatment, the number of organ with failure, the use of antibiotics within 1 hour,and incidence of AKI or ALI/ARDS within 24 hours were risk factors of 28-day death (P ＜ 0.05 or P ＜ 0.01).It was shown by the logistic regression analysis that aging [odds ratio (OR) =4.81, P =0.02], failure of 2 organs (OR =28.63,P =0.00) or ≥ 3 organs (OR =62.69, P =0.00) were the independent risk factors for mortality in patients with septic shock.④ The 76 patients of late group were subdivided into three groups, namely 6-hour reaching standard of EGDT group (n =22), 24-hour reaching standard of EGDT group (n =28), and non-reaching standard of EGDT group (n =28).Compared with those before treatment, the Lac after therapy was decreased obviously both in 6-hour EGDT group and 24-hour EGDT group, and the CVP, MAP, and ScvO2 were increased significantly.The Lac in 6-hour EGDT group was lowered more significantly as compared with that in 24-hour EGDT group (mmol/L: 1.64 ± 0.40 vs.3.01 ± 1.13, P ＜ 0.01),while MAP and ScvO2 were increased significantly [MAP (mmHg): 81.82 ± 8.01 vs.69.01 ± 9.63;ScvO2:0.718 ± 0.034 vs.0.658 ±0.036, P ＜ 0.05 and P ＜ 0.01].The urine output in both reaching standard of EGDT groups was more than 0.5 mL·h-1·kg-1, without statistically different significance.The 28-day mortality rate of 24-hour EGDT group was 14.29％, and it was 0 in 6-hour EGDT group.Conclusions Mortality was as high as 68.96％ during 10 years when the period before the use of 2004 SSC, and the mortality rate was lowered to 34.21％ during 10 years during which the early fluid resuscitation treatment was based on EGDT.Aging and failure of more than 2 organs were independent risk factors for mortality in patients with septic shock.Compared with reaching the standard of EGDT within 24 hours,reaching the standard of EGDT within 6 hours can rapidly reverse hypoxic-ischemic tissue, thereby improving the prognosis of the patient with lowering of mortality rate.

Breast cancer is one of reproduction-endocrine related tumors, so the risk factors including environmental and genetic factors which can disrupt anabolism and function of estradiol may increase the risk of breast cancer. Persistent environmental endocrine disruptor chemical (EDCs) can disrupt anabolism and function of endogenous hormone and the degree of disruption may depend on genetic polymorphism. EDCs and metabolic enzyme genetic polymorphism were discussed in this paper. To study the risk factors of breast cancer, both of the environmental factors and the genetic factors should be included.

Objective To evaluate the value of color Doppler flow imaging(CDFI) in the diagonosis of placental site trophoblastic tumor(PSTT). Methods After being examined by transvaginal CDFI, four of six patients underwent curettage and two of them had hysterectomy and attached by chemical treatment. All the patients were verified to have a PSTT by pathology. Results The image of PSTT in CDFI included different size at different site, low resistence index (RI) of vessel around the lesion, and absence of vessel in the lesion. Conclusions The characteristic image in CDFI is helpful to the diagnosis of PSTT.

AIM: To contrast the effect of small incision phacoemulsification and non-phacoemulsification to treat cataract.
METHODS: Totally 172 patients with cataract were divided into 2 groups ( n = 86 ) randomly. Patients in Group Phaco were treated with phacoemulsification and, while those in Group Siecs were treated with small incision extracapsular cataract surgery and intraocular lens implantation. They were all followed up for 1-3y. Functional examinations were made at 3d;1,6mo and last follow - up. The visual acuity, intraocular pressure, anterior chamber depth, average corneal power ( ACP ) , cylinder ( CYL ) , surface asymmetry index ( SAI ) and complications were contrasted between groups.
RESULTS: At 3d after operation, the visual acuity of Group Phaco was better than that of Group Siecs ( P<0-05), and CYL, SAI and intraocular pressure of Group Phaco were all significantly lower than those of Group Siecs (P<0. 05). At 1mo after operation, the visual acuity of Group Phaco was better than that of Group Siecs ( P<0-05), and CYL, SAI and intraocular pressure of Group Phaco were slightly lower than those of Group Siecs ( P<0. 05);there was no difference between the two group. At 6mo after operation, the visual acuity of Group Phaco was still better than that of Group Siecs (P<0. 05), and CYL, SAI and intraocular pressure of Group Phaco were flat as those of Group Siecs (P<0. 05); there was no difference between groups in those indexes above ( P > 0. 05 ). Furthermore, the APC and anterior chamber depth of each point- in - time had no significant difference between groups (P>0. 05). The incidences of complication were similar in two groups ( P> 0. 05 ); but with individual differences, patients of GradeII and Ⅲ in Group Phaco got lower complication rate (P<0. 05), while those of Grade Ⅳ higher (P<0. 05) than those of Group Siecs.
CONCLUSION: Our research shows that phacoemulsification has high effect in the treatment of patients with GradeII and Ⅲ nuclear hardness, while small incision extracapsular cataract surgery has high effect in the treatment of patients with Grade Ⅳ nuclear hardness.

Community health service is an effective measure to relieve the difficult medical services and expensive medical cost problem,but community inhabitants in Chongqing make little use of community health service.The actual cause is that people s degree of trust in community health service is low.In view of existing situation,this article analyzes the various factors that influence community residents' degree of trust in community health service and puts forward corresponding policy proposal.

Tumor-derived heat shock protein-peptide complex 96 (HSPPC-96) containing tumor antigenic peptides can elicit po-tent tumor-specific and protective immunity. Autologous HSPPC-96 vaccine has been shown to effectively prolong recurrence-free sur-vival and increase the overall survival of many tumors, thereby suggesting extensive future applications. However, as an autologous tu-mor-derived individual vaccine, the development of HSPPC-96 vaccine is challenged by the lack of an adequate autologous tumor, lim-ited efficacy for advanced-stage cancer, etc. This paper summarized the progress, future perspectives, and challenges in the clinical de-velopment of HSPPC-96 vaccine immunotherapy.

Non-invasive coronary artery angiography is one of the hotspots of imaging.This article reviewed the status and the relevant advancement of the cardiac EBCT, DSCT, MSCT and MR imaging.

A total of 17 hip joint lesion patients (24 hips) combined with ankylosing spondylitis and severe osteoporosis from March 1996 to March 2003.They.received autologous impaction bone graft and cementless total hip replacement.They were 20-52 years old,averagely 35 years.Harris score and X-ray method were used to evaluate clinical outcomes.A total of 17 patients (24 hips) were followed up for 36-120 months,averagely 87 months.Harris score increased from averagely 34 points (preoperation) to averagely 86.4 points (postoperation),resulting in an excellent and good rate of 87.5%.Radiograph showed that femoral prosthesis was closely fixed to proximal segment of the femur,without prosthetic infection or dislocation.One hip suffered from 5-mm prosthetic subsidence within 1 year following replacement,and no further subsidence following over 5-year follow up.The prosthesis showed good contact to sclerotin,without loose.It is suggested that bone mass has great effects on cementtess prosthetic replacement.Autologous impaction bone graft for bone remodeling provides a good method for total hip replacement in patients combined with ankylosing spondylitis and severe osteoporosis.The clinical outcome is satisfactory.

The fetal inlfammatory response syndrome (FIRS) is a subclinical condition characterized by systemic acti-vation of the fetal innate immune system with a large number of pro-inlfammatory cytokines released. FIRS is the fetal coun-terpart of the systemic inlfammatory response syndrome (SIRS) described in adults. Intrauterine infection is the most common reason of FIRS. FIRS has been implicated as a cause of preterm labor, preterm white matter injury, bronchopulmonary dyspla-sia (BPD) and necrotizing enterocolitis (NEC).