Objective To investigate the clinical significance of ligating the portasystemic shunt confirmed by preoperative CT evaluation during orthotopic liver transplantation. Methods From January 2007 to August 2008, 35 patients in Tianjin First Central Hospital underwent preoperative three-dimensional CT scan, among them 23 patients had spontaneous major portasystemic shunts, the other 12 patients did not have portasystemic shunts. 16 out of the 23 cases with significant shunts underwent shunt ligation based on portal blood flow volume measured by intraoperative portal vein flowmetry. The shunt of the other 7 patients were left untreated. Results The portal blood flow in the 12 patients without portasystemic shunt as judged by preoperative CT scanning were (1101±70) ml/min. The shunts in 7 patients with portal blood flow greater than 1000 ml/min were not ligated, that of the 16 patients with portal blood flow volume lower than 1000 mL/min were ligated. The portal blood flow volume in those 16 patients before and after ligating the shunt were (657±112) m//min and (1136±161) ml/min, respectively (P<0.05). Postoperatively 2 patients suffered from portal vein thrombosis, among them 1 patient suffered from intermittent disturbance of consciousness, 2 patients died within 3 months, with one dying of respiratory failure from pulmonary aspergillus infection one dying of hepatic failure in 2 months after operation because of graft dysfunction.The other 19 patients with normal blood flow and well-functioning graft were alive. Conclusion The ligation of portasystemic shunt is mandatory in patients when pretransplant CT evaluation showing a major porto-systemic shunts and portal blood flow volume was less than 1000 ml/min.

Objective To observe the effect of small interfering RNA(siRNA) targeting Survivin gene on survivin expression,proliferation and apoptosis of hepatocellular carcinoma cell line MHCC-97H.Methods Survivin sequence specific siRNA was designed and synthesized.siRNA/liposome complex was transfected into hepatocellular carcinoma cell line MHCC-97H.The MHCC-97H cells were divided into Survivin siRNA group(Si-survivin),negative control siRNA group(NC group)and blank group (normal control group).Survivin mRNA and protein expressions were detected by reverse transcription-PCR and Western blot,respectively.The proliferation of MHCC-97H was measured by methythiazolydiphenyl-tetrazolium bromide assay.The Annexin V/PI double labeled flow cytometry was employed to measure the apoptosis at 24 h after transfection in different concentrations of Survivin siRNA(12.5,25.0 and 50.0 nmoL/L,respectively).Results After 48 h of transfection,the Survivin mRNA levels were 0.55 ± 0.16 (Si-survivin group),0.85 ± 0.28 (NC group) and 0.93 ± 0.40 (normal control group),respectively,which were significantly different among 3 groups (F =414,P ＜ 0.01).The level of Survivin mRNA was the lowest in Si-survivin group,which was statistically different with NC group and normal control group (t =-20.56,-28.37,all P ＜ 0.001).The levels of Survivin protein expression in 3 groups were 0.602 ± 0.005 (Si-survivin group),0.835 ± 0.007 (NC group) and 0.993 ± 0.003 (normal control group) at 48 h after transfection,which were statistically different among 3 groups (F =238,P ＜0.01).The lowest level of protein expression was in Si-survivin group,which was statistically different with NC group and normal control group (t =-40.17,-66.03,all P ＜ 0.001).After 72 h and 96 h of transfection,the inhibitory rate of cell growth was significantly higher in Si-survivin group [(19.5 ± 3.6)％,(12.0 ± 0.9)％] compared with that in NC group [(3.6 ± 0.9) ％,(-1.3 ± 6.1) ％] (t--36.18,42.53,all P ＜ 0.05).The apoptosis rates in 12.5,25.0,50.0 nmol/L Survivin siRNA were (22.64 ± 2.54) ％,(35.37 ± 3.28) ％ and (53.28 ± 4.35) ％,respectively.However,in NC group and normal control group,the apoptosis rates were (8.77 ± 1.25) ％ and (9.72 ± 1.37) ％.The rates were statistically different among those 5 groups(F =35.93,P ＜0.01).And in the apoptosis rates of siRNA groups in different concentratiom were statistically different when compared between each two groups (t =-29.73,-38.57,all P ＜ 0.001).Conclusion Survivin specific siRNA can inhibit the proliferation and induce the apoptosis by blocking Survivin gene expression in hepatocellular carcinoma cell line MHCC-97H.

Anterior shoulder instability is a very difficult issue to treat,especially with glenoid bone defect.When the defect is small,there is little influence on shoulder instability.The larger the defect is,the more influence there will be.Most authors agree that glenoid bone reconstruction should be considered when glenoid bone defect is more than 20％-25％.In this condition soft tissue procedures alone are not enough to provide stability to the shoulder.To date,there is still not an ideal typing of glenoid bone defect.There are many methods of assessing the size of bone defect.Pico system is one of the most common methods,as it is easier and more precise.Numerous surgical procedures have been described to address the bone defect.The Bristow procedure,the Latarjet procedure and the Eden-hybinette procedure are effective and most popular around the world.The Latarjet procedure can provide more bone blocking than the Bristow procedure,and is more popular.The Eden-hybinette procedure dose not need coracoid transfer and then has no damage of normal anatomical structure.But it also lack the hanging effect of the conjoint tendon.After all,each procedure has its advantage and disadvantage in treating anterior shoulder instability associated with glenoid bone defect and should be chosen depending on the characteristics of each patient and the preference of each surgeon.Furthermore,more new and effective treatments are still needed.

Objective To evaluate systematically the clinical efficacy of surgery combined with anti-TNFalpha in treatment of Crohn's disease (CD) with perianal fistula.Method Database including China Biology Medicine disc,Wan Fang Database,PubMed,Cochrane Library and EMBASE were searched withCrohn's disease,anal fistula,fistula,perianal fistula,surgical procedure,surgery,surgical,anti-tumor necrosis factoralpha,anti-TNF-alpha,TNF-alpha,克罗恩病,Crohn's病,肛瘘,手术治疗,外科手术,抗肿瘤坏死因子α制剂,肿瘤坏死因子,肿瘤坏死因子配体超家族员2”between the database establishment and June 2016.Literatures of retrospective case-control studies about surgery combined with anti-TNF-alpha therapy and single surgery in treatment of CD with perianal fistula were retrieved.Data were extracted and evaluated by 2 independent researchers.Patients who underwent surgery combined with anti-TNF-alpha therapy were allocated into the combined therapy group and patients who underwent single surgical treatment were allocated into the surgery group.The complete healing rate,partial healing rate and recurrence rate after therapy were compared between the 2 groups.Count data were represented as the odds ratio (OR) and 95％ confidence interval (CI).The heterogeneity was analyzed by theI2 test.Result Six retrospective case-control studies were retrieved and total sample size was 598 patients,including 256 in the combined therapy group and 342 in the surgery group.The result of Meta analysis showed that there was no significant difference in postoperative complete healing rate and partial healing rate between the 2 groups (OR =1.36,1.47,95 ％ CI:0.94-1.97,0.56-3.88,P ＞ 0.05),and recurrence rate after therapy in the combined therapy group was significantly lower than that in the surgery group (OR =0.26,95％ CI:0.16-0.44,P ＜ 0.05).Conclusion The complete healing rate and partial healing rate of patients with CD with perianal fistula undergoing surgery combined with anti-TNF-alpha therapy are not superior to that undergoing single surgical treatment,however,recurrence rate after therapy is lower for patients undergoing surgery combined with anti-TNF-alpha therapy.

Objective To study the role of human carcinoembryonic antigen-related cellular adhesion molecule 1 (hCEACAM1)in mediating the specific adhesion of N. gonorrhoeae to its human host cells.Methods A recombinant eukaryotic expression vector pCDPGICEA1 was constructed by putting hCEACAM1 cDNA behind both hCD46 promoter and rabbit β-globulin intron 2,and with which,the COS-1 cells were transfected. Following G418 selection, the COS-1 cells expressing hCEACAM1 were sorted out with flow cytometry. The adhesion of N. gonorrhoeae to the gene transfected COS-1 cells was analyzed with bacterial binding assay. Results hCEACAM1 cDNA could be expressed effectively under the direction of hCD46 promoter and rabbit β-globulin intron 2,and N. gonorrhoeae could adhere to COS-1 cells expressing hCEACAM1. Conclusion hCEACAM1 can mediate the adhesion of N. gonorrhoeae to animal originated COS-1 cells. thus its transgenic mice may be used as a novel animal model for studying N. gonorrhoeae infection.

Objective To investigate the underlying mechanism of Huayu Xiaozheng granule(HYXZ)in the treatment of ectopic pregnancy(EP).Methods The potential ingredients and targets of HYXZ were identified and screened.PPI network,GO enrichment and KEGG pathway analysis were established to understand the potential and intricate mechanism of HYXZ in treating EP.The effects of HYXZ on HTR-8/SVneo cells migration and invasion were detected by wounding healing assay and transwell migration assay respectively,as well as the influence of HYXZ granule on JAK/STAT pathway and associated proteins were assessed by western blot under the control of JAK/STAT pathway inhibitor and agonist.Results A total of 375 active ingredients,45 known targets and 207 predicted targets of HYXZ were obtained.A PPI network has constructed to know the relationship of 252 common targets of drug targets and disease targets,from which we screened out 15 key targets:STAT3,MMP9,TLR4,HIF1A and others.Scratch test showed that HYXZ inhibited the migration of the HTR-8/SVneo cells cells in a time and dose-dependent manner;Transwell test showed that the number of transmembrane cells decreased significantly(P<0.05)after 48 h with various concentrations of HYXZ;Western blot experiment showed that the expression of JAK/STAT pathway protein decreased significantly(P<0.05);and the expression of its related proteins uPA,HIF1and N-cadherin were inhibited(P<0.05),the tendency of which was consistent with the inhibitor AG490,but opposite to the agonist IL-6.Conclusion HYXZ inhibited JAK/STAT pathway,and associated proteins uPA,HIF1A and N-cadherin,thereby suppressing the mobility and invasiveness of the HTR-8/SVneo cells,which is conductive to clarify the mechanism of HYXZ in the treatment of early EP.

OBJECTIVEThis retrospective study is performed to analyze the epidemiological and clinical features of patients with infective endocarditis (IE) hospitalized in Fuwai Cardiovascular Hospital during the latest 7 years.

METHODSThis retrospective study included a cohort of 368 infective endocarditis patients hospitalized in Fuwai Hospital form August 2005 to August 2012. Predisposing cardiac diseases, causative organisms, clinical features and outcomes were analyzed. Risk factors related to outcome including NYHA classes, causative organisms and complications, were evaluated.

RESULTSAmong the IE patients, 6.8% (25/368) patients had rheumatic heart diseases 31.8% (117/368) had congenital heart diseases, 22.8% (84/368) were post-PCI or operative endocarditis and IE developed in 14.1% (52/368) patients without previous cardiac diseases. Blood culture positive rate was 46.2% (170/368). Streptococci viridians [27.6% (47/170) ]were the most common causative organisms, followed by coagulase-negative staphylococci [15.9% (27/170) ]. Fever and cardiac murmur were the most common clinical presentations. Congestive heart failure was the most common complication [87.8% (323/368)]. Systemic and pulmonary embolism occurred in 16.0% patients, 80.9% IE was detected by echocardiography. In-hospital mortality rate was 6.7%, mostly due to refractory congestive heart failure and sepsis. Subgroup analysis showed that incidence of post-PCI or operative endocarditis was significantly higher in IE patients hospitalized after 2009 compared to IE patients hospitalized before 2009 (27.5% vs. 19.2%, P < 0.05) . Higher incidence of staphylococcal infection was evidenced in mechanical valves than in native valves (44.4% vs. 19.8%, P < 0.05).

CONCLUSIONDuring the past decade, there is a significant change on epidemiology and clinical features of IE in China. Incidence of post-surgical and interventional IE increased significantly. Staphylococcal and Gram negative bacilli infection are major pathorganisms of endocarditis of mechanical valves. Due to the lower positive rate of blood culture, echocardiography serves as the most important diagnostic tool for infective endocarditis.

Adult ; Endocarditis ; epidemiology ; microbiology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors

Objective To investigate the biological response of survivin siRNA in A549 human lung cancer cells and Hela S3 human cervical cancer cells as well as K562 human erythroleukemia cells,in order to screen the working sequences of survivin siRNA.Methods Three sequences of survivin-targeted siRNA were designed and synthetized,and human cancer lines of A549,Hela S3,K562 were transfected with Hiperfect liposome entrapped survivin siRNA,respectively.The expression of survivin mRNA was detected by means of real-time polymerase chain reaction (RT-PCR) with SYBR Green Ⅰ.Cell proliferation was detected by way of WST-8 cell count kit at 48 hours and 72 hours after transfection.Results The expression of survivin mRNA in all 3 cancer cells studied was significantly inhibited by all siRNA at 48 hours and 72 hours after transfection,gene expression inhibition ratio were 57.47％-88.53％ after transfection 48 hours and were 69.94％-95.03％ after transfection 72 hours.Cell proliferation was also significantly inhibited 48 hours and 72 hours after transfection,cell multiplication inhibition ratio were 27.88％-47.36％ after transfeotion 48 hours and were 42.59％-57.29％ after transfeciton 72 hours.Sequence 1 had the most inhibition efficacy on survivin gene expression and proli-feration in tumor cells.Inhibition rate of the three tumor cell gene expression of survivin at 48 hours are above 75％,72 h all over 90％,48 hours of cell proliferation inhibition rate are above 40％,72 hours of more than 50％.Conclusions The chemo-synthesized siRNAs can significantly down-regulate survivin mRNA expression in cancer cell studies.Survivin siRNA is capable of inhibiting the proliferation of tumor cell in vitro and it might be a new strategy for tumor-targeted therapy.Sequence 1 is the most efficacious working survivin siR-NA in the study.

Objective:To explore the effectiveness of the Shewhart control chart-based assessment and early warning system in prevention of medical device-related pressure injury(MDRPI).Methods:152 critically ill patients admitted to Hebei Central Hospital from January 2020 to December 2021 were selected and divided into a control group and an observation group based on different methods of assessing MDRPI risk,with 76 cases in each group.The control group adopted the Braden scale to assess the risk of MDRPI.The observation group adopted a safety early warning system based on Shewhart control charts to assess the risk of MDRPI in patients.Nursing measures were undertaken according to MDRPI risk grade in both groups.The occurrence of adverse events of MDRPI,nursing safety quality and nursing comprehensive quality were compared between the two groups.Results:The incidence rate of head,neck and face adverse events of MDRPI and the total incidence of adverse events of MDRPI of the patients in the observation group were lower than those in the control group(x2=4.802,5.758,P<0.05).The safety quality and comprehensive quality of nursing of 20 nurses in the observation group were higher than those in the control group(t=6.654,7.172,P<0.05).Conclusion:The application of assessment and early warning system based on Shewhart control chart in clinical nursing management can effectively reduce the incidence of MDRPI adverse events and improve the quality of nursing safety and comprehensive nursing.

Objectives:This study aimed to evaluate the predictive value of the CHA 2DS 2-VASc score for in-hospital outcomes of patients with acute myocardial infarction (AMI). Methods:Data of 23 728 patients from the China patient-centered Evaluative Assessment of cardiac Events (China PEACE)Retrospective Acute Myocardial Infarction Study were analyzed retrospectively. The patients were categorized into 3 groups according to the CHA 2DS 2-VASc scores: the low score group (score 1-3), the middle score group (score 4-6) and the high score group (score 7-9). The in-hospital outcomes included major adverse cardiovascular events (MACE), death, death or withdrawal from treatment, reinfarction, ischemic stroke,etc. The CHA 2DS 2-VASc score was incorporated into multivariate Cox regression analyses to determine its independent impact on in-hospital outcomes. Receiver operating Characteristic (ROC) curves were constructed, and the area under the curve (AUC) was used to evaluate the predictive value of the CHA 2DS 2-VASc score for in-hospital mortality and death or withdrawal from treatment, respectively. Results:The patients had a median age of 66 (56,75) years, and 30.7% of them were females. Patients with higher CHA 2DS 2-VASc scores had a higher in-hospital mortality and more in-hospital complications (all P<0.001). After adjustment of baseline covariates, the subjects in the high score group were associated with high risks of in-hospital mortality ( OR=6.13, 95% CI 4.77-7.87, P<0.001), death or treatment withdrawal ( OR=6.43, 95% CI 5.16-8.00, P<0.001) and MACE ( OR=4.94, 95% CI 4.06-6.01, P<0.001). The AUCs of the CHA 2DS 2-VASc score were comparable with those of the mini-global registry of acute coronary events(mini-GRACE)score in evaluation of in-hospital mortality (0.699 vs. 0.696, P=0.752) and the death or treatment withdrawal risk (0.708 vs. 0.713, P=0.489). Conclusions:The CHA 2DS 2-VASc score is an independent predictor of in-hospital outcomes for patients with AMI. Its predictive value was comparable with the mini-GRACE score, which could be used as a simple tool for early and rapid outcome evaluation for AMI patients.