Endoscopic treatment is the main therapy for controlling variceal bleeding and secondary prophylaxis of rebleeding of gastroesophageal varices of portal hypertension. Endoscopic treatment of gastroesophageal varices are developing towards individualization, precision and whole management in recent years. We can diagnose the etiology and characteristic of portal hypertension through medical history, physical examination, laboratory and radiological tests. It is important to identify the etiology of portal hypertension that can control the progress of varices. There is a complex classification of varices. Individualized stratification and treatment selection are based on the results of endoscopic finding, contrast computed tomography (CT), hepatic venous pressure gradient, etc. Modified precise endoscopic injection of cyanoacrylate is important part to improve the efficacy and reduce the complications of endoscopic treatment. We need to pay attention to the complications and comorbidities of portal hypertension, comprehensive management with the multidisciplinary teams, that is the most important thing to improve the efficacy of endoscopic treatment and the prognosis of patients with portal hypertension.

Objective:To evaluate the influence of Tweed-Merrifield technique in correction of severe bimaxillary protrusion adult patients on the measurement of the dental and skeletal changes after orthodon-tic treatment by Johnston analysis and the regular cephalomatric analysis.Methods:Twelve adolescent patients with severe bimaxillary protrusion were included in this self-control retrospective study.Lateral cephalometric radiographs were taken before and after treatments.All the radiographs were traced and analyzed by the method of Johnston analysis.Other measurements were evaluated using a series of 1 3 li-near and angular measurements including SNA,SNB,ANB,U1 -SN,U1 -NA,U1 /NA,L1 -NB, U1 /NB,L1 /MP,U1 -L1 ,(U1 +L1 )/2-AB,MP/SN and MP/FH from regular cephalomatric analysis. These measurements were also applied to compare the differences between pre-and post-treatments,which clarify the dental and skeletal changes by Johnston analysis.The effect of orthodontic correction was de-termined using the non-parameters test.Results:The maxillary moved backforward by 1 .3 mm according to the stable skull base,while the mandible moved forward by 2.1 2 mm.The relative position between the maxillary and mandible (ABCH)changed 3.42 mm.The upper and lower incisors retracted signifi-cantly.The upper and lower molars moved slightly forward and the relative positions of upper and lower molars and anterior teeth after treatment were 3.44 mm and 4.23 mm respectively.After treatment,the parameters of ANB、U1 -NA、U1 /NA、U1 -SN、L1 -NB、L1 /NB and L1 -M were reduced by -(1 .98 ± 1 .55)°(P =0.01 2),-(5.08 ±4.6)mm (P =0.002),-(1 1 .79 ±1 .21 )°(P =0.004),-(1 3.55 ±6.32)°(P =0.047), -(3.1 7 ±3.07)mm (P =0.01 0), -(6.84 ±2.55)°(P =0.038)and-(4.1 3 ±2.24)°(P =0.048)on average,whose changes had the statistically significant effects.Con-clusion:Tweed-Merrifield technique (directional force technique)can stabilize anchorage molar,retract anterior teeth and significantly improve the hard and soft tissue profile for patients with bimaxillary protru-sion,and make a good vertical control which means this technique is applicable to the patients who need strong anchorage.Even for the severe bimaxillary protrusion adult patients,the Tweed-Merrifield tech-nique can control the anchoragewell and make the profiles improved greatly.

Objective To investigate the effects of the leflunomide active metabolite (A771726) on the expression of phorbol-12-myristate-13-acetate (PMA) -induced CD147, matrix metallo-proteinase (MMP)-2 and MMP-9 on THP-1 cells. Methods THP-1 cells were cultured in RPMI-1640 medium supplemented with 10％ fetal bovine serum. For all experiments, THP-1 cells were cultured at an initial density of 5×105/ml. Before A771726 treatment, cells were cultured with serum-free RPMI-1640 medium for 12 h, THP-1cells were co-cultured with PMA at three different concentrations of A771726 (5, 15 , 45 μg/ml) for 24 h.The mRNA expression of CD147, MMP-2 and MMP-9 was measured by real-time PCR. CD147 expression on the cells were evaluated by flow cytometric analysis. The activity of MMP-2 and MMP-9 were evaluated by gelatin zymography. Statistical differences among the groups were tested by one-way ANOVA or KruskalWallis test. Results The expression of CD147, MMP-2 and MMP-9 were upgraded by the PMA. The expression of CD147 on THP-1 cells was inhibited significantly by A771726 in a dose-dependent pattern (P＜0.01). The mean fluorescence intensity (MFI) of CD147 in positive control group was 109.5±3.8, the MFI in A771726 (5, 15, 45 μg/ml) group were 73.3±2.5, 64.5±2.3, 40.9±2.7, respectively. The expression of MMP-2, MMP-9 mRNA and the activity of MMP-2, MMP-9 in the supernatant was inhibited significantly by A771726 (P＜0.01). The expression of CD147 mRNA was not inhibited significantly by A771726 (P＞0.05).Conclusion Leflunomide active metabolite (A771726) can inhibit the expression of PMA-induced CD147,MMP-2 and MMP-9 on THP-1 Cells.

Objective To observe the effect of infliximab combination therapy on the expression of CD147 on the peripheral CD14+ monocytes of active rheumatoid arthritis (RA) patients. Methods Thirty active RA patients who were refractory to MTX treatment were randomized into three groups (group A, B, C) with the proportion of 3:1:1. Group A and B received four or three infusions of infliximab (3 mg/kg), group C received four infusions of placebo. All three groups were added to a stable background of MTX. The mean fluorescence intensity (MFI) of CD147 expression on the peripheral CD14+ monocytes of RA patients and normal healthy controls were detected by flow cytometry analysis. Clinical and laboratory parameters were assessed before each infusion. One-way ANOVA, Kruskal-Wallis the MFI of CD147 expression at week 18 (P<0.05). Marked differences were observed between the infliximab + MTX group and the placebo + MTX group on the change of the MFI of CD147 expression from baseline to week 18 (P<0.05).Conclusion CD147 expression on the peripheral CD14+ monocytes of active RA patients is increased, and combination therapy of infliximab and MTX can inhibit the expression.

Objective To analyze the correlation between serum interleukin (IL)-33 and early rheumatoid arthritis (RA) by testing the serum IL-33 of patients with RA.Methods One hundred patients with early RA whose disease duration was less than 1 year were selected,40 patients with osteoarthritis (OA) and 70 healthy controis were selected.The serum IL-33 levels of the three groups were detected by enzyme-linked immunosorbent assay (ELISA).The correlation between serum IL-33 levels and clinical features of patients with RA were analyzed.Kruskal-Wallis test,Mann-Whitney U test,X2 test and Spearman correlation analysis were used for statistical analysis. Results The level of serum IL-33 in RA patients [(282±871)pg/ml ] was significantlv higher than that of the healthy controls [(7±38) pg/ml,P

Objective To investigate the protective effect and its mechanism of DL-3-n-Butylphthalide on the brain damage in rats following whole brain irradiation.Methods A total of 120 male Sprague Dawley rats were randomly divided into sham-irradiation group,irradiatien group and DL-3-n-Butylphthalide group.The model of whole-brain irradiatien was established by exposuring rat brain to 4 MeV X-rays with a single-dose of 10 Gy.The rats were intraperitoneally injected with DL-3-n-Butylphthalide at the dosages of 0.3,1.0,and 3.0 mg/kg once a day.The contents of malondialdchyde and super oxide dismutase activity were measured,while the expressions of apoptosis-associated genes and the ultrastructural changes in hippocampus were examined by immunohistnchemisty staining and electron microscope,respectively.Results After irradiation,the content of malondialdehyde and the expression of apoptosis gene bax in rat brain tissue increased while the activity of super oxide dismutase(SOD) and the expression of anti-apoptosis gene bcl-2 decreased.Apoptosis was also observed in the neurons of hippocampus CA1.Compared with irradiation group,the content of malondialdehyde and the expression of bax gene in the DL-3-n-Butylphthalide group wen significantly reduced ( t =-3.89--1.96,2.72-3.48,P ＜ 0.05 ),while the activity of SOD and bcl-2 gene were significantly elevated ( t =2.94-3.76,-3.18--2.08,P ＜ 0.05),and the injury degree of neuron structure in the DL-3-n-Butylphthalide group was slighter than that in the irradiation group.Conclusions DL-3-n-Butylphthalide executes protective effects in a dose-dependent manner againest the radiation injury in rats brain by reducing the induction of malondialdehyde,raising the activity of SOD and inhibiting the generation of apoptosis.

Objective:The aim of this study was to investigate the prognostic value of vitamin B12 as the non-invasive biomarker to predict long-term rebleeding rate in cirrhotic patients with esophagogastric varices.Methods:From Dec 1, 2016 to Dec 31, 2017, cirrhotic patients with esophagogastric varices who had been admitted to Zhongshan Hospital affiliated to Fudan University were enrolled. All these patients received endoscopic treatment to prevent variceal rebleeding. The serum vitamin B12 and folic acid levels were measured in all of them. The receiver operating characteristic (ROC) analysis, Kaplan-Meier analysis, univariate and multivariate cox regression analysis were conducted to explore the value of vitamin B12 in predicting 3-year variceal rebleeding in cirrhotic patients with esophagogastric varices after endoscopic treatment.Results:115 patients were included. The ROC curve analysis indicated that the optimal cutoff value of vitamin B12 for 3-year variceal rebleeding was 567.25 pg/ml. According to the cut-off value, the patients were divided into high-level vitamin B12 group ( n=49) and low-level vitamin B12 group ( n=66). Compared with the low vitamin B12 group, the high vitamin B12 group had lower albumin level, less male (63.3% vs 80.3%), and higher 3-year rebleeding rate ( P<0.05). Cox analysis showed that vitamin B12 and platelet were independent prognostic factors for 3-year rebleeding in patients with variceal bleeding. Conclusions:Elevated peripheral blood vitamin B12 predicts a higher risk of long-term rebleeding in patients with liver cirrhosis and esophagogastric varices.

Objective To analyze the medical service pricing policy of 30 provinces and autonomous regions in China and recommend on problems and challenges, for reference of medical service pricing reform in the future.Methods Literature review and policy analysis were used for summary and performance appraisal of medical service pricing of China.Results Most of the areas surveyed followed the step-by-step approach to gradually adjust pricing, while a few areas completed it in a one-time adjustment manner.2015 witnessed most areas, up to 20 (66.67%), in price adjustment;their price adjustments focused on price reduction of large-scale medical equipment inspection fees and some medical tests.On the other hand, prices of diagnosis, nursing care, and treatment which are labor-intensive were increased.Conclusions Specifications of medical services are improving, yet there exist great gaps in the convergence of medical insurance.It is advisable to expedite the convergence of the new version specifications, to achieve value regression and dynamic price adjustment of medical services.

Objective:The study was designed to evaluate the efficacy in polycystic ovary syndrome (PCOS) of glucagon-like peptide-1 receptor agonists (GLP-1RA), metformin combined with thiazolidinediones, α-glucosidase inhibitor, and inositol.Methods:Eligible studies were searched in databases of PubMed, EMBase, Cochrane Library, Wanfang data, and CNKI based on population, interventions, comparisons, outcomes, and study design (PICOS) principle (inception to Nov 2020). Two researchers independently screened randomized controlled trials in strict accordance with the inclusion and exclusion criteria, extracted basic information and outcomes of included studies, and used Cochrane risk of bias tool to evaluate the methodological quality of the literature. Network meta-analysis was conducted by STATA 14.0. Continuous variables without dimensional differences were calculated by weighted mean difference and 95% CI, and continuous variables with dimensional differences were calculated using standardized mean difference and 95% CI. Results:A total of 27 studies with 1 445 patients were included in this study. Network meta-analysis showed that acarbose presented a better efficacy than other interventions in reducing total testosterone [surface under the cumulative ranking curve (SUCRA): 89.4%]. GLP-1RAs may have the best efficacy in reducing body mass index and homeostasis model assessment for insulin resistance (HOMA-IR; SUCRA: 99.1%, 89.2%, respectively), while using inositol may be a good choice to reduce serum fasting insulin, HOMA-IR, blood total cholesterol, and blood triglycerides (SUCRA: 94.5%, 85.4%, 96.6%, and 82.8%, respectively).Conclusions:Acarbose may have advantages over other antihyperglycemic drugs in lowering blood testosterone. GLP-1RAs are more helpful to improve body mass index and HOMA-IR in PCOS patients. Inositol, as an insulin sensitizer, has a favorable effect on reducing fasting insulin, HOMA-IR, blood total cholesterol, and blood triglycerides, and there are no reports of side effects in current researches. Further study is still needed to confirm its efficacy.

According to the pathophysiological characteristics, upper gastrointestinal bleeding can be divided into acid related disease bleeding and esophageal and gastric varices bleeding. Esophageal and gastric variceal bleeding is a common critical condition of Portal hypertension, with dangerous onset and high mortality. With the improvement of endoscopic treatment technology, endoscopy has become the first line treatment plan for esophageal and gastric variceal bleeding. The commonly used endoscopic management methods for varicose veins include variceal ligation, tissue glue combined with sclerosing agent embolization, ultrasound guided coil combined with tissue glue embolization, and other management measures. Early identification of gastrointestinal bleeding related to varicose veins, stratified diagnosis and treatment of high-risk patients, reasonable selection of endoscopic examination timing, and personalized decision-making of treatment choices are key to improving efficacy.