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 explore target organ damage in the youth with pre-hypertension. Methods 77 consecutive youth visiting our institution form 2008 to 2010 were divided into pre-hypertension group (n=32) and control group (n=45). The relevance of left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVDd), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), carotid plaque intima-media thickness (IMT) and glomerular filtration rate (GFR) were compared. Results The blood pressure of pre-hypertension group was higher than that of control group, and the pre-hypertension group followed higher family hypertension history (P<0.05). There was no difference in LVDd, IVST, LVPWT, carotid plaque IMT and GFR between 2 groups (P>0.05). Compared with the control group, LVMI increased (P<0.05) and the E/A ratio decreased (P<0.05). Conclusion Target organ damage in pre-hypertension youth is salient compared with changes in renal function and damage of arteriosclerosis, and heart damage is more often occurred in the obese youth with pre-hypertension.

To investigate various microRNAs (miRNAs) expression levels in cancer associated fibroblasts (CAFs) of gastric cancer,and to explore the effects of miRNA214 in CAFs on the invasion and migration of gastric cancer cells.Methods The primary CAFs were isolated from human gastric tumor tissues,while the normal fibroblasts (NFs) were from adjacent normal gastric mucosa tissues.Real-time quantitative PCR (RT-PCR) was performed to detect the expression level of miRNAs in CAFs and NFs.The interaction model in vitro between CAFs and MGC-803 (a gastric cancer cell line) was established by Transwell chamber,and then the effects of miRNA-214 in CAFs on MGC-803 invasion and migration were analyzed.Results It was found that the expression level of 18kinds of miRNAs in CAFs was different.Moreover,the expression level of miRNA-214 in CAFs was most observably decreased compared with NFs.Further studies indicated that over-expression of miRNA-214 in CAFs could markedly inhibit the migration and invasion ability of gastric cancer cells in vitro.Conclusion The expression of miRNAs was different between CAFs and NFs,and the miRNA-214 expression in CAFs is markedly reduced compared with NFs.The over-expression of miRNA-214in CAFs could significantly inhibit the migration and invasion ability of gastric cancer cells.Therefore,miRNA-214 in CAFs might act as a tumor suppressor in gastric cancer progression.

OBJECTIVE To have an retrospective analysis of the prevalent fungi infected in patients in ICU,and their pathologic sites and drug resistance and to find out the hazard factors.METHODS The research used API 20C AUX and Rosco disk diffusion method to test the drug resistance of fungi isolated from the infected samples collected from ICU patients in our hospital between Jan 2006 and Mar 2007.RESULTS Totally 123 fungi strains were spotted,the majority of them being Candida albicans,accounting for 34.1%;Candida glabrata 26.8% and Candida tropicalis 18.7%.All the fungi were sensitive to amphotericin B and nystatin(Mycostatin) and partially resistant to fluconazole,itraconazole and ketoconazole.Patients with long term use of wide-spectrum antibiotics and catheters and elder patients would have higher fungi infection rate.CONCLUSIONS Candida are the major pathogens of fungal infections in ICU.The major infected site is lower respiratory tract.Amphotericin B and nystatin have good sensitivity but higher toxicity.Conazole medicines also have good sensitivity to C.albicans and C.tropicalis.But they are resisted largely by C.glabrata and C.krusei.Reasonable use of bacteriophage and reduction of unnecessary diagnosis and treatment procedures,and early discovery,diagnosis and treatment are keys to prevent and cure the invasive fungal infections.

Objective To study the effect and safety of modified Valdivia position and prone position in percutaneous nephrolithotomy(PCNL) on renal calculi.Methods The clinical data of 94 patients with solitary renal calculi admitted in our hospital from September 2015 to November 2016 were enrolled to this study,who were divided into control group and study group by surgery methods and body position,47 cases in each group.The control group received PCNL with prone position,and the study group were treated by PCNL with modified Valdivia position.The operative condition,postoperative condition,stone clearance rate and incidence of adverse reactions between the two groups between two groups were compared,and the levels of diastolic blood pressure(DBP),systolic blood pressure(SBP) and heart rate(HR) between the two groups were observed.Results After position placement,DBP and SBP level decreased in both groups,the level of DBP and SBP in study group were lower than the control group,the difference was significant(P<0.01).There was no significant difference in the level of HR between two groups(P>0.05).The operative time,intraoperative blood loss,hospitalization time,reoperation rate and blood transfusion rate in the study group were lower than those in control group,the differences were significant(P<0.05),the removal rate of stones was significantly higher than that of control group(χ2=9.55,P=0.00).The rate of chest stuffy and dysphoria in the study group were higher than those in control group(P<0.05).The incidence of infection,hemorrhage,pleural injury and renal injury were slightly lower than those of the control group,but there was no significant difference between two groups(P>0.05).Conclusion PCNL with modified Valdivia position has high safety and significant effect on patients with kidney stones,which can effectively remove stones,reduce operation time.

Objective To explore the application of scene simulation teaching combined with research design in the teaching of Community Nursing and evaluate its effects.Methods The scene simulation teaching combined with research design was used in the teaching of Community Health Promotion and Health Education in 68 nursing undergraduate students.The student groups were required to do the scenario case preparation and presentation,and conduct the research design according to specific situations of community health education.The mastery of related knowledge of students before and after the class was compared.Results All the student groups completed the course requirements.After class,the students better grasped the community health education,research design and other related knowledge compared with before class.Sixty-one students (89.71％) regarded the scene simulation teaching combined with research design was suitable for the teaching of Community Health Promotion and Health Education,and over 80％ students regarded this teaching was benefit for the development of their ability of self-learning,teamwork and flexible application of knowledge.Conclusions The scene simulation teaching combined with research design can not only help students master related knowledge,but also focuses on students' ability training,which is suitable for comprehensive application of knowledge.

Objective To study the short-term clinical outcomes of unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis,and to compare 2 kinds of unicompartmental prosthesis.Methods From March 2010 to June 2013,data of 43 patients underwent unicompartmental knee arthroplasty (UKA) were retrospectively analyzed.17 patients (17knees) used rotating platform prosthesis,and 26 patients (28 knees) used fixed bearing prosthesis.There were 7 males (7 knees)and 9 females (10 knees) in rotating platform group,with an average age of 64.1 years (range,54-82 years);while 10 males (10knees) and 17 females (18 knees) in fixed bearing group,with an average age of 62.2 years (range,43-79 years).All patients presented signs of narrowed medial joint space,medial tenderness and pain on weight-bearing.X-ray and MRI were used for documenting joint narrowing and cartilage defect.The pain and the knee functions were recorded both pre and post-operatively with knee society score (KSS),2 cases of simultaneous anterior cruciate ligament (ACL) reconstruction were assessed with TegnerLysholm knee scoring scale as well.Results All 43 patients were followed up for 6 month to 37 months,and the average duration was 21.1 months.There were no dislocations,joint infection,deep venous thrombosis,prosthetic loosening,etc.The KSS in rotating platform group was 56.11 ±9.51 preoperatively,and 92.23±5.46 postoperatively.While the KSS in fixed bearing group was 57.11 ±9.56,and 93.69±6.37,respectively.There were statistical differences comparing between preoperative and postoperative KSS knee scores.There was no significant difference in KSS scores between rotating platform group and fixed bearing group.Conclusion Unicompartmental knee arthroplasty is a less invasive and effective method for knee osteoarthritis in medial compartment with less complications.There was no significant difference in clinical outcomes between rotating platform and fixed bearing design in terms of patients' satisfactory rate,clinical and functional outcomes in this short-term follow-up study.

The business process reengineering is accomplished by setting up at the operation room a pre-op ready room,an anesthesia induction room,and an anesthetic recovery room.With the aid of the computerized management system,a system platform is built to connect anesthetists,blood bank and pathology lab.This can optimize operation room management,shorten turn-over time before operations,improve efficiency,and cut back hospital costs for an all-win outcome.

Objective To investigate the immunological activity change of regulatory T cells (Treg) and discuss its significance in the outcomes of patients with multiple organ dysfunction syndrome (MODS) and severe burn. Methods A total of 106 patients with total burn surface area (TBSA) larger than 30% were included in the study and randomly divided into three groups according to the burn area: Group Ⅰ (TBSA of 30%-49%, n = 41), Group Ⅱ (TBSA of 50% -69%, n = 34) and Group Ⅲ (TBSA of 70%-99%, n = 31). According to the development of MODS, patients were divided into MODS group (n =21) and non-MODS group (n =85). The patients with MODS were further divided into non-survival group (n = 16) and survival group (n = 5) based on their outcomes. Healthy volunteers were served as normal control (n = 25). Peripheral blood samples were collected at days 1,3,7, 14 and 21 postburn. The immunomagnetic separation technique was applied to separate and purify CD4+ CD25+Tregs in peripheral blood, and phenotypes (CTLA-4) were analyzed by flow cytometry and the contents of interleukin-10 released in the supernatants were determined by ELISA. Results Expression of CTLA-4 and level of IL-10 were significantly increased in burn patients compared with normal control group, with statistical differences. The expression of CTLA-4 and level of IL-10 were significantly increased in patients with severe burns at all time points. The expression of CTLA-4 and level of IL-10 in MODS group were much higher than those in non-MODS group at days 3-21 postburn (P ＜ 0.01). Among the MODS patients, the expression of CTLA-4 and level of IL-10 in the survival group were obviously lower than those in the non-survival group at days 3-21 postburn (P ＜ 0.05 or P ＜ 0.01). Conclusions After severe burn injury, expressions of the markers on CD4 + CD25 + Treg surface and secretion of cytokines produced by CD4 + CD25 + Tregs show significant difference in patients with different born areas, MODS development and survival state. CD4 + CD25 + Treg may play an important role in the pathogenesis of immunoregulation, MODS and mortality of burn patients through secretion of inhibitory cytokines.

Aim Toclarifytheeffectofacteosideon proliferation of neural stem cells (NSCs ) from adult mice,as well as the involved signaling pathway.Meth-ods NSCswereisolatedfromthesubventricularzone (SVZ)of adult C57BL/6 mice,then identified by im-munofluorescence staining with Nestin,the marker of NSCs.NSCs were exposed to acteoside (5,10,20,40μmol·L-1 )in absence of mitogen(EGF/bFGF)for 24 h.We employed CCK8 assay to detect NSCs viability and BrdU staining to identify NSCs proliferation.We performed Western blot to quantify the expression level ofp-AktinducedbyacteosideonNSCs.Results With-out mitogen,acteoside increased NSCs proliferation by activating p-Akt,which can be blocked by LY294002, the inhibitor of PI3K/AKT signaling pathway.Conclu-sion ActeosidepromotestheproliferationofNSCsfrom adult mice by activating PI3K/AKT pathway.