Objective To investigate the process of Stark cesarean section (CS) and analyze its key procedures and patients outcomes in order to understand its advantages and promote its standardization. Methods Elective Stark CS cases were divided into two groups according to time sequence and procedure difference. Group A refered to cases underwent modified approaches before standardization (n=362), and group B refered to cases afterward (n= 302). Duration of operation, time interval from incision to delivery, intraoperative hemorrhage, postoperative flatus time, postoperative morbidity, duration of retained urinary catheter, urinary tract irritation, wound infection, and abdominopelvie adhesion in the second operation were compared between the two groups. Results The average duration of the operations and time interval from incision to delivery in group B, which were (27.7± 10. 8) min and (4.92±1.21) min, respectively, were significantly shorter than those in group A, which were (35.6±15.2) min and (7.81±2. 79) min, respectively (P<0. 05). No significant differences was found with regard to average intraoperative hemorrhage between group A and B [(214.34±62. 1) ml vs (201.54-53.1) ml, P>0.05]. Postoperative flatus time in group B was significantly shorter than that in group A [(16.85±11.8) h vs (25.9±12. 7) h, P<0. 05]. Postoperative morbidity in group B was significantly lower than that in group A [1.3%(4/302) vs 4.7%(17/362), P<0.05]. The average duration of retained urinary catheter in group B was significantly shorter than that in group A [(15.6±5.3)h vs (26. 2±6.1)h, P<0. 05], and the urinary tract irritation rate in group B was also lower than that in group A [2. 5%(9/362) vs 0(0/302), P < 0. 05)], No incisional infection or delayed healing was found in either group. Rectus muscles, fascia and peritoneum adhesions were found in three cases with second surgery in group A and none in group B. No omentum, peritoneum and visceral peritoneum adhesion was found in either group. Conclusions Compared to the modified Stark operation, standardized procedure decreases operation associated complications and improves maternal outcomes. Therefore, standardized Stark CS should be promoted for better operative outcomes.

Objective To investigate the prevalence and clinical features of tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Methods All articles published in Chinese between 1998-2008 were searched by using "systemic lupus erythematosus (SLE)" and "tuberculosis infection" as the keywords.Data were extracted and then Meta-analysis was done. Results Four hundred and twenty-four patients with the age(32±9) years from 30 studies were available for analysis, in which 45 were males and 379 were females. The duration of SLE when TB infection was diagnosed was (26±19) months.TB was found in 2.3%～19.6% of patients and 15.6% of them died. 73.0% of patients of SLE were in stable phase when infected with TB.7.50% of patients had a history of TB infection years ago. The common manifestations observed were fever (95.2%), weight loss (63.1%), cough and expectoration (60.2%), night-sweat (47.8%), chest pain (44.7%), chest distress and dyspnea (41.1%). 35.0% of patients had hematogenous disseminated pulmonary tuberculosis and 15.1% of patients had tuberculous meningitis. 45.3% of patients had extra-pulmonary TB. The focus of infection could not be identified in 2.8% of patients. Both ESR and CRP were elevated in patients(93.9%, 77.1%), but the positive rate of tuberculin test, anti-TB antibody and sputum smear posivity was low (19.3%, 41.8%, 14.3%). Conclusion TB incidence in patients with SLE is evidently high and the clinical mani-festation is not typical. Extra-pulmonary TB and serious infection are more frequently. Severe TB infection and extra-pulmonary TB are frequent. More patients with SLE are in stable phase when infected with TB. Early diagnosis of TB infection is important.

Objective To explore the molecular mechanisms involved in liver regeneration after different cold ischemic (CI) times for the liver graft in 30% volume rat liver transplantation. Methods A model of 30% volume Lewis to lewis rat liver transplantation with hepatic artery reconstruction was established. Rats were grouped as follows: 1 h CI group (n =25), 8 h CI group (n =25) and 16h CI group (n = 25). Survival rate of rats in each group and liver regeneration were observed. Specimen were collected at predetermined intervals from 90 min, 1,4 and 7 d post-reperfusion. TNF-α and IL-6 expression, STAT3 activation were determined in liver grafts. Expression of cyclin D1 and hepatocyte replication with BrdU uptake were studied by immunohiatochemistry. Statistical analysis was used to compare BrdU positively stained hepatoeytes at 1 d post- reperfusion in each group. Results 30% liver transplantation was performed in a total of 75 rats. Compared with rats in 1 h CI group, TNF-α and IL-6 expression in 8 h CI and 16 h CI groups were markedly increased after 30% liver transplantation. STAT3 activity in 8 h CI and 16 h CI groups was significantly increased. Cyclin D1 expression in 8 CI group was demonstrated with cytoplasmic and nuclear staining. Grafts in 16 h CI group showed large areas with no cyclin D1 expression. Number of hepatoeytes with positively stained neclei in 1 h CI group was more than that in 8 h CI group at 1 d after transplantation (t = 6.14, P < 0.05). Conclusion Liver regeneration following 30% liver graft transplantation may be through TNF-α/IL-6/STAT3/ Cyclin D1/DNA synthesis pathways. The reason for 30% liver graft failure with significant cold ischemic injury is that hepatocytes may not respond to initiating signals for liver graft regeneration.

Objective The college and university students' physical exercise behavior scale has been de-veloped. Methods Baaed on the theory of planning behavior,after investigation and analysis,a questionnaire was made to test 1180 students from some colleges and universities in Changjiang Delta area. Its reliability and validity was tested,and confirmatory factor analysis was carried out. Results The scale consists of 4 factors: behavioral intention,subjective criterion,cognitive behavior,and integrative attitude. Its retest reliability was 0.920, correla-tion coefficient of the factors between 0.732 and 0.854 ,and the total scale Cronbach α 0.931. The correlated co-efficients between subseales and total scales range 0.455～0.785 ;the IFI, CFI,and NFI fit indices of the four di-mensions were over 0.9 ;RMSEA 0.042. Conclusion The reliability and validity of the scale are suitable as an effective tool to test university students' sports exercise behavior.

BACKGROUND: Sampling the autogenous bone always needs to develop the second operational area or harvest surrounding the implant, which will increase the risk of trauma and infection. Therefore autogenous bone powder may be taken into consideration to reclaim and use for the treatment of local bone defect.OBJECTIVE: To construct experimental models of repairing bone defect by autogenous bone powder and implant material, and observe the biocompatibility between materials and host.DESIGN: Single sample observation.SETTING: College of Stomatology, Dalian Medical University.MATERIALS: The experiment was performed at the Animal Experimental Center of Dalian Medical University from August 2005 to April 2006. Five healthy hybrid dogs were used in this study. Titanium nail and Bio-Oss bone implant materials were designed and produced by Xi'an Zhonghang Titanium Biological Materials Co., Ltd.METHODS: The first, second and third premolars of dogs were uprooted and received implantation 3 months later. Four implant sockets were prepared at left and right sides respectively of each dog, totally 40 sockets. One titanium nail was implanted into each socket, totally 40 nails. Autogenous bone powder collected when drilling hole, Bio-Oss implant materials and their mixture at 1:1 were implanted in artificial bone defect at bucca side, respectively, while non-implanted bone was served as blank control.MAIN OUTCOME MEASURES: ①At week 9, recovery of bone mass was recorded. Height of alveolar bone, density of bone trabecula and osseointegration were observed by X-ray film.②Histological change was determined by methylene blue-basic fuchsin method.RESULTS: No titanium nail fell off, so five dogs were all involved in the result analysis.①General condition and bone defect: At week 9 of implantation, wound was well healed, and the titanium nail was stable with total reserved rate of 100%. Compared with blank control, the bone defect mass was less in bones implanted with autogenous bone powder (P＜0.01), and the least in bones implanted with mixed powder, which had optimal recovery.②Recovery of bone mass: X-ray film demonstrated that, 40 titanium nails were closely connected with bone, and the healing was well.③Biocompatibility between materials and host: All titanium nails were closely surrounded by erythroic compact bone, no blue soft tissues were seen between implant materials and bone, and direct bone interface appeared under low power lens.CONCLUSION: It is effective to repair bone defect by autogenous bone powder and implant material in dog models,good hiocompatibility is observed between materials and host.

To identify the role of spinal cyclooxygenase (COX)-1 in the development and maintenance of postoperative pain, we examined the changes of COX-1 protein expression in lumbar spinal cord by immunohistochemistry and Western blot technique in rat plantar incision model at different time points (pre-incision or 2 h, 4 h, 6 h,12 h, 1 d, 2 d, 3 d, 5 d and 7 d after incision). We also studied the anti-allodynic effects of the COX inhibitors by intrathecal administration of non-selective COX inhibitors (ketorolac), selective COX-1 (SC-560) or COX-2 inhibitor (NS-398) immediately or 2 h, 24 h after incision. The mechanical allodynia was evaluated by using paw withdrawal threshold (PWT) response to mechanical stimulation on pre-incision, 2 h, 1 d, 2 d, 3 d, 5 d and 7 d after incision or 30 min after drug treatment. The result showed that COX-1 immunoreactive cells mainly focused in the superficial laminae of lumbar spinal dorsal horn and expression of spinal COX-1 protein increased after incision, peaked at 4 h (P＜0.01) and lasted for 12 h. Postoperative treatment with both SC-560 and ketorolac significantly alleviating the mechanical allodynia induced by skin incision, but NS-398 had no such effect. This study demonstrates that spinal COX-1 involves in the development and maintenance of postoperative hypersensitivity and intrathecal COX-1 inhibitor has anti-allodynic effect on incision pain in the rat.

BACKGROUND: It has been shown that patients managed with hemodialysis experience decrease of quality of life. But there are a few reports about the relationship between the self-management behavior such as dietary behavior, taking medicine, management behavior of physical sign etc and health-related quality of life (HRQOL) in hemodialysis patients.OBJECTIVE: To study the relationship between self-management behavior and HRQOL in Chinese hemodialysis patients,especially potential association of self-management behavior variables with indicators of HRQOL in order to improve their quality of life (QOL).DESIGN: Sampling investigation based on hemodialysis patients.SETTING: Nursing department and dialysis center in a university hospital. PARTICIPANTS: This research was completed in the Nursing Department of First Hospital Affiliated to China Medical University. Totally 120hemodialysis patients,63 males and 57 females,aged 19 -79 years old with the mean age of(52 ± 12),were selected from the First and Second Hospital Affiliated to China Medical University,the First Affiliated Hospital of Dalian Medical University,the Central and the Second Hospital of Shenyang Medical College,from July to September 2003. Inclusion criteria: Patients above 18years old,dialysis history more than 3 months with twice or three times every week,understanding the questionnaires and being volunteers. Exclusion criteria: Patients with acute disease and mental disorder.METHODS: Self-administered questionnaire was used to measure self-management behavior and short-form 36 health survey(SF-36) was used to measure HRQOL of patients with hemodialysis. Correlation and multivariate regression analysis were used to test the relationship between self-management behavior and HRQOL.MAIN OUTCOME MEASURES: Self-management behavior and HRQOL.RESULTS: Totally 107 questionnaires were available. Multivariate regression analysis indicated that management of physical,psychosocial activity was the significant factor of.physical component summary(regression coefficient = 2.709,R2 =0. 150,P<0.01),and management of physical sign,psychosocial behavior was the significant factor of mental component summary(regressioncoefficient=1.126,R2=0.041,P<0.05).CONCLUSION: Improving hemodialysis patients' management of physical,psychosocial activity and management of physical sign could help hemodialysis patients to raise their HRQOL.

The strategy of silico cloning based on the express sequence tags sequence (ESTs)and genome database is a new technique developed in recent years,and the core of the technique is to use bioinformatics technique to assemble and extend ESTs to get part of cDNA and even all sequence.It has the virtue of low investment,high speed,low and well-targeted technical requirements,etc.The relationship between human disease and genes has been widely confirmed,therefore,silico cloning technology will become the important means of disease research.This paper aims at elaborating the progress of silico cloning in medicine.

This study is to investigate the effect of (2-methyl-n-butyl) shikonin (MBS) on inducing apoptosis of human gastric cancer cell line SGC-7901 and the role of ERK1/2 signal pathway in the apoptosis. MTT assay was used to detect SGC-7901 cell proliferation. DNA condensation was measured by DAPI stain. Cell apoptosis was analyzed by flow cytometry. Mitochondrial membrane potential (MMP) was analyzed by JC-1 staining. The protein expressions of Bcl-2, Bax, Survivin, cleaved caspase-9, cleaved caspase-3, cleaved PARP, p-ERK1/2, ERK1/2, p-JNK, JNK, p-p38 and p38 were detected by Western blotting. The results showed that MBS reduced the cell viability of SGC-7901 cells in a dose- and time-dependent manner. The IC50 at 24 h and 48 h for SGC-7901 cells was 10.113 and 4.196 micromolL(-1), respectively. After being treated with MBS, the typical nuclear condensation was observed in SGC-7901 cells by DAPI stain. Apoptosis in SGC-7901 cells was induced by MBS in a dose dependent manner. The protein expression of Bcl-2 was down-regulated, while the protein expressions of cleaved caspase-9, cleaved caspase-3, cleaved PARP, p-ERK1/2 and p-JNK were up-regulated after MBS treatment. U0126, a specific MAP kinase (MEK1/2) inhibitor, blocked the ERK1/2 activation by MBS. MMP was decreased by MBS treatment. It can be concluded that MBS could inhibit SGC-7901 cell proliferation and induce apoptosis. Mitochondrial apoptosis pathway, ERK1/2 signal pathway and JNK signal pathway might be involved in this process.

BACKGROUND:Femoral head necrosis induced by glucocorticoid is typical under mechanics load.OBJECTIVE:To create the rat models of the femoral head necrosis by long-term glucocorticoid treatment,and to Observe the changes of femoral head necrosis induced by glucocorticoid under mechanics load.METHODS:Wistar rats with 4-month old were randomly divided into the experimental and control groups.After the buttocks injection of dexamethasone 20mg/kg weakly for 8 weeks,rats in the experimental group were made to run on the running machine at a speed of 1 km/h to forme the hyper-weight model;at the same time those in the control group were with the normal physiological weight.Rats in both groups were sacrificed at weeks 2,4,6 and 8.The left legs were taken for the biomechanics test on the EnduraTEC ELF3200,the biggest vertical deformation and stiftness were calculated,the number of empty osteocyte lacunas was calculated,and the cumulative absorbance value was compared between two groups.RESULTS AND CONCLUSION:The femoral head presented with necrosis at 8 weeks in the experimental group.and the width of bone trabecula,and the stiffness of which were smaller than that of the control group.but the biggest vertical deformation was greater the concurrent control group(P＜0.05).The Bcl-2 cumulative absorbance value of 2 groups had significant differences at 4 weeks(P＜0.05),which was increased with time prolonged in the experimental group(P＜0.05).The results demonstrated that:in glucocorticoid-induced osteonecrosis of the femoral head,mechanics Ioad induces the obviously osteocyte necrosis.more cartilage repair,and trabeculae rupture,which is considered as the direct reason of the necrosis of the femoral head The typical femoral head necrosis is presented.