Objective To discuss the technique and clinical value of laparoscopic splenectomy (LS) without using Endo-GIA combined with pericardial devascularization for the treatment of cirrhotic portal hypertension. Methods From March 2005 to October 2006, 23 patients with cirrhotic portal hypertension-induced lower esophageal varices were treated with LS combined with pericardial devascularization. In 18 of the cases, the spleen was resected by disconnection of the secondary splenic pedicle without using endo-GIA. During the operation, the splenic vessels were separated and disconnected by using absorbable clip or ligation respectively. And then the lesser omentum was cut using ultrasonic knife, and the pericardial varices devascularization was performed using the absorbable clips or ultrasonic knife. Finally, the spleen was placed into a bag, broken into small pieces, and removed from an enlarged trocar hole. Results The operation was completed successfully in the 18 cases. The mean operation time was 255 min (range,180-320 min). The mean intraoperative blood loss was 450 ml (range, 200-1600 ml). After the operation, 2 patients developed plural effusion, 1 had subphrenic abscess, and 2 had mild ascites. The subphrenic abscess was cure by ultrasonography-guided puncture. The mean hospitalization was 7.5 days (range 6 to 17 days). No mortality occurred. All the patients were followed up for an averge of 16.4 months (range 5 to 24 months). No patient died after the operation. The mean hospital stay was 7.5 days (6-17 days). The cases were followed up for 5-24 months (mean, 16.4 months). One patient developed rebleeding 20 months after the operation, and was cured by injecting sclerosing agent under a gastroscope. The other 17 cases had no hemorrhage after the operation.Conclusions It is a low-cost and superior method to disconnect the secondary splenic pedicle without using endo-GIA in LS combined with pericardial devascularization for the treatment of cirrhotic portal hypertension.

Objective To study the mechanism of lentinum's promotion on carvedilol's effects on dilated cardiomyopathy's heart function.Methods SD rat model of dilated cardiomyopathy was established with doxorubicin hydrochloride.The rat model was divided into blank control group,carvedilol group,lentinan group,carvedilol + lentinan group.Rats in the blank control group were given 2 mL of 0.9％ sodium chloride solution.Rats in the carvedilol group were given 10 mg·kg-1of carvedilol and 2 mL of 0.9％ sodium chloride solution.Rats in the lentinan group were given 1 mg·kg-1 of lentinan,and 2 mL of 0.9％ sodium chloride solution.Rats in the carvedilol + lentinan group were given10 mg· kg-1 of carvedilol,1 rmg·kg-1 of lentinan,and 2 mL of 0.9％ sodium chloride solution.The heart function,irrflammatory factors and T lymphocytes were compared.Results The left ventricular ejection fraction (LVEF) in carvedilol + lentinan group and carvedilol group were significantly higher than that in blank control group and lentinan group (P ＜ 0.05),while Tei index was significantly lower (P ＜ 0.05).The LVEF in carvedilol + lentinan group was significantly higher than that in carvedilol group (P ＜0.05),while Tei index was significantly lower (P ＜0.05).The hs-CRP,TNF-α,II-6 and IL-8 in carvedilol + lentinan group and lentinan group were significantly lower than that in blank control group and carvedilol group (P ＜0.05),while IL-10,CD3+,CD4+ and CD8+ were significantly higher (P ＜ 0.05).The hs-CRP,TNF-α,II-6 and IL-8 in C + L group were significantly lower than in lentinan group (P ＜ 0.05),while IL-10,CD3+,CD4+ and CD8+ were significantly higher (P ＜ 0.05).Conclusion Lentinan could significantly promote carvedilol's effects on dilated cardiomyopathy's heart function through lowering down inflammatory factors and increasing T lymphocytes.

BackgroundRevascularization and statin therapy are routinely used in the management of stable coronary artery disease. However, it is unclear whether the estimated high-density lipoprotein (HDL) particle size (eHDL-S), the ratio of HDL cholesterol (HDL-C) to apoprotein A-I (apoA-I), is associated with the clinical outcomes of diabetic patients with stablecoronary artery disease (CAD).MethodsWe per-formed a prospective cohort study of 328 patients diagnosed with stable CAD by coronary angiography. Patients were followed up for a mean duration of 12 months. The patients were divided into three groups by the tertiles of eHDL-S: low eHDL-S (< 0.71,n= 118); interme-diate eHDL-S (0.71-0.79,n= 111); and high eHDL-S (> 0.79,n= 99). The associations between the baseline eHDL-S and short-term out-comes were evaluated using the Kaplan-Meier method and Cox proportional regression.Results The low eHDL-S group had higher trig-lyceride, hemoglobin A1c, uric acid, and leukocyte count than the other groups. During the follow-up period, 47/328 patients experienced a pre-specified outcome. According to the Kaplan-Meier analysis, the incidence of pre-specified outcomes was lower in the high eHDL-S group (P = 0.04). However, eHDL-S was not independently associated with adverse outcomes in Cox proportional hazards regression (haz-ard ratio (HR): 0.23, 95% confidence interval (95% CI): 0.01-11.24,P = 0.493).ConclusionAlthough the eHDL-S was associated with inflammatory biomarkers, it was not independently associated with the short-term prognosis of diabetic patients with stable CAD in the era of revascularization and potent statin therapy.

A wide range of computer and internet applications impact on people's lifestyles andways of thinking profoundly, Internet acculturation is an important research issue in the information age.By the literature review,this paper summed up the themes of medical students' internet acculturation:in-ternet addiction disorder research,internet morality anomie research and internet learning adaptation re-search.Some suggestions for future research were put forward at last.

type of extreme heat with yin asthenia.But discrepancy of CO and EF between type of deficiency of both QI and YIN and type of QI-stagnation and blood stasis all had not statistical significance.Conclusion: In clinic to aim directly at left ventricular contractile dysfunction of senile diabetics,no matter syndrome differentiation belonging to type of deficiency of both QI and YIN,type of QI-stagnation and blood stasis or type of deficiency of both yin and yang,all can benefit after treatment with supplementing QI and activating blood circulation method;but syndrome differentiation belonging to type of extreme heat with yin asthenia advocates not to use supplementing QI and activating blood circulation method.

YAEH.But ET was no statistical significance discrepancy among DBQY,DBYY and QSBS.Conclusion: In clinic to aim directly at left ventricular diastolic dysfunction of senile diabetics,no matter syndrome differentiation belonging to DBQY,DBYY,QSBS,all can benefit after treatment with supplementing QI and activating blood circulation method;but syndrome differentiation belonging to YAEH advocates not to use supplementing QI and activating blood circulation method.

Objective To investigate the clinicopathologic features of the brain tissue from multilobar resection or hemispherectomy for refractory epilepsy. Methods The clinical and pathologic findings of 46 cases seen at Xuanwu hospital from 2005 to 2009 were reviewed retrospectively. Results The mean age of seizure onset and disease duration were 3.9 years and 10.2 years, respectively. There were 33 cases of hemispherectomy and 13 cases of multilobar resection. Temporal lobe abnormality was seen in all cases. The pathologic subgroups were as follows: ulegyria (31/46), malformation of cortical development (MCD, 7/46 ) and infection (8/46). Microscopic examination of ulegyria showed cortical architectural disturbances, neuronal loss, reactive gliosis and appearance of corpora amylacea. We also noted deposition of hemosiderin (13 cases), calcification (9 cases) and island-like neurons (5 cases). All ulegyria cases were accompanied by varying degree of cortical dysplasia, and hippocampus sclerosis were identified in 7 cases. MCD comprised of 5 cases of focal cortical dysplasia ( FCD), including 3 cases of FCDⅠB, 1 case of FCDⅡA and 1 case of FCDⅠA, 1 case of polymicrogyria and 1 case of porencephaly. Among 8 infection eases, there were 5 cases of Rasmussen encephalitis ( RE), l case of cysticercosis, 1 case of tuberculous meningitis and l case of Cytomegalovirus encephalitis. Conclusions The most common pathological category of specimens from hemispherectomy or multilobar resection is ulegyria with obvious temporal lobe abnormality. This is followed by MCD ( with FCDⅠB as the main type) and central nervous system infection (RE as the most frequent abnormality).

Aim To investigate the effects of diallyl di-sulfide( DADS) on G2/M arrest in Chk1/MGC803 and Chk2/MGC803 cells so as to establish stable human gastric cancer MGC803 cells with overexpression of Chk1/2 gene. Methods The colony formation, flow cytometry, RT-PCR and Western blot were used to de-tect the proliferation, cell cycle, and expression of Chk1/2 mRNA and protein, p-Chk1/2, CDC25C and cyclinB1, respectively. Results The colony formation showed that the colony forming efficiency in Chk1/MGC803 and Chk2/MGC803 cells treated by 30 mg· L-1 DADS was lower than in control group and vector group ( P <0. 05 ) . Flow cytometry demonstrated that 41. 3%, 57. 4%, 68. 9% and 42. 9% of G2/M cells in Chk1/MGC803 were increased than in MGC803 and Chk2/MGC803 , respectively after treated by DADS in 12,24, 36 and 48 h(P <0. 05). At the same time, RT-PCR disclosed that expression of Chk1 and Chk2 mRNA had no marked change. Western blot showed that total proteins of Chk1 and Chk2 and p-Chk2 had invisible change, but expression of p-Chk1 was up-reg-ulated, and CDC25C and cyclinB1 were down-regula-ted time-dependently in Chk1/MGC803 cells ( P <0. 05 ) . Conclusion DADS arrests MGC803 cells at G2/M by increasing p-Chk1 expression to cause down-regulation of CDC25C and cyclinB1 simultaneously.

Objective To investigate the elinieopathologie features of refractory epilepsy. Methods The clinical and pathologic features of refractory epilepsy of 273 cases undergoing surgical treatment in Xuanwu Hospital from January 2005 to December 2007 were reviewed retrospectively. Results The mean age of seizure onset and disease duration were 11.0 years and 11.2 years respectively. The following pathologic subgroups were identified: malformation of cortical development (MCD, 158/273) including focal cortical dysplasia (FCD) type Ⅰ (104, the mean age of seizure onset and disease duration were 11.1 years and 11.2 years respectively), FCD type Ⅱ (30, the mean age of seizure onset and disease duration were 7. 9 years and 12. 7 years respectively) , mild MCD (6) , tuberous sclerosis complex (6) and other types (9) , brain turnouts (26/273, the mean age of seizure onset and disease duration were 14. 5 years and 6. 3 years respectively), ulegyria (63/273), brain infections (13/273), vascular malformation (3/273), cyst (3/273), cholesteatoma (1/273) and other unknown types (6/273). Dual pathology was identified in 31 of 158 MCD cases. Eighty-six of 134 (64. 2%) FCD cases were type Ⅰ B predominantly seen in temporal lobe. Twenty of 26 (76. 9%) brain tumours were mixed neuronal-glial tumours predominantly located in temporal lobe. Cortical dysplasia was often seen in these cases. Conclusions The 3 most common causes of refractory epilepsy are MCD, ulegyria and brain tumours. The predominant subtype of FCD is type Ⅰ B often located in temporal lobe, in which associated hippoeampal sclerosis is often seen. Brain tumors in patients with refractory epilepsy are almost benign neoplasms located in temporal lobe, in which the most frequent type is mixed neuronal-glial tumour.

Objective To study the locations of P-glycoprotein(P-gp),multi-drug resistanceassociated protein (MRP) and lung resistance.related protein(LRP)in brain tissue of focal cortical dysplasia (FCD) and to compare the quantity of these proteins in different brain tissues in an effort to study the mechanism of refractory epilepsy and to provide theoretical basis for medical treatment in patients with epilepsy.Methods The brain tissues of 16 cases with refractory epilepsy were collected during surgery,including 8 cases of focal cortical dysplasia type Ⅰ(FCD Ⅰ)and 8 cases of focal cortical dysplasia type Ⅱ (FCD Ⅱ) Five cases of glioma without history of epilepsy were included as the control group.Envision method was used to observe the location and intensity of expression of these three proteins.Western-Blot was used to analyze these proteins quantitatively.Results In brain tissue,the locations of P-glycoprotein,multi-drug resistance-associated protein and lung resistance-related protein were difierent.P-gp located mainly in capillary endothelial cells;MRP in neurons components;the location of LRP included capillary endothelial cells,balloon cells and the matrix of lesions.The expressions of three proteins in brain tissue of FCD were significantly higher than in control group(P-gp:0.520 ±0.121,MRP:0.132±0.018,LRP:0.092.±0.018,U=0.000,P<0.01).The expressions of P-gp and LRP in lesions of FCD Ⅱ(3.809 ±0.842 and 0.655±0.303,respectively)were higher than that in surrounding regions(2.636 ±0.622 and 0.290±0.096,U value were 6.000 and 4.500,both P<0.01).Conclusions P-gp,MRP and LRP expressed at different position of focal cortical dysplasia,suggesting that their roles were distinctive.