Objective To evaluate the efficacy of endoscopic variceal ligation(EVL)in esophageal variceal bleeding (EVB)in elderly patients with hepatic cirrhosis,and the safety of endoscopic operation under anesthesia.Methods From July 2007 to July 2013,170 patients diagnosed as liver cirrhosis complicated with EVB were retrospectively analyzed.Among them,139 patients who received EVL were divided into elderly anesthesia group (n=52,age≥60 years),elderly non-anesthesia group (n=45 ,age≥60 years)and non-elderly anesthesia group (n=42,age<60 years);the other 31 cases (age≥60 years) received propranolol therapy.The degree of satisfaction of visual fields and esophageal peristalsis under the gastroscope,the effect,adverse effects and complications of EVL,the recurrence of EVB and mortality of each group were analyzed.Two-way analysis of variance and crosstabs chi square test were performed for statistical analysis.Results The satisfaction rate of visual fields and esophageal peristalsis under the gastroscope were 82.5 % (104/126)and 89.7% (113/126)in elderly anesthesia group;82.6% (71/86) and 89.5 % (77/86)in non-elderly anesthesia group;40.3% (29/72)and 44.4% (32/72)in elderly non-anesthesia group.The satisfaction rate of visual fields and esophageal peristalsis under the gastroscope in anesthesia group were better than those in non-anesthesia group (χ2 =47.46,64.28;both P <0.01 ). The efficacy rates of EVL in elderly anesthesia group,elderly non-anesthesia group and non-elderly anesthesia group were 84.6%(44/52 ),68.9%(31/45 )and 81 .0%(34/42 ),respectively.The variceal recurrence rates were 19.2% (10/52 ),20.0% (9/45 )and 19.0% (8/42 ),respectively.There was no significant difference among them (all P > 0.05). Rebleeding rate of medication treatment group was 58.1%(18/31),which was obviously higher than that of elderly anesthesia group (19.2%,10/52 ), elderly non-anesthesia group (31 .1 %,14/45 )and non-elderly anesthesia group (23.8%,10/42 ),and the difference was statistically significant (χ2 =15 .10,P <0.01 ).No case of hepatic encephalopathy was found in elderly anesthesia group or non-elderly anesthesia group after EVL.The incidence of pneumonia in elderly non-anesthesia group was 4.2%(3/72),which was higher than that of elderly anesthesia group and non-elderly anesthesia group,and the difference was statistically significant (χ2 =8.93,P =0.01). The mortality within a month after EVL in elderly anesthesia group,elderly non-anesthesia group and non-elderly anesthesia group was 0,8.9% (4/45 )and 0,and the difference was statistically significant (χ2 =9.27,P =0.01).Conclusion The efficacy of EVL under anesthesia in EVB in elderly patients with liver cirrhosis was good,with no induction or aggravation of hepatic encephalopathy or irreversible complications were found.

Objective To evaluate the clinical efficacy of endoscopic esophageal variceal ligation (EVL) for esophageal variceal bleeding (EVB) in elderly patients with hepatic cirrhosis.Methods From July 2007 to July 2013,clinical data of 198 patients who had been diagnosed with liver cirrhosis presenting with EVB were retrospectively analyzed.Among them,167 patients who had received EVL were divided into the elderly EVL group (n=97,age≥60 years) and the non-elderly EVL group (n=70,aged ＜ 60 years).The other 31 cases (aged ≥ 60 years) had received propranolol therapy.Treatment effectiveness,adverse effects,complications and the one-year survival rate of each group were analyzed.Results The efficacy rates and variceal recurrences were 77.3％ (75/97) and 78.6％ (55/70) in the elderly EVL group and 19.6％ (19/97) and 18.6％ (13/70) in the non-elderly EVL group,respectively,with no significant difference between the two groups (each P＞0.05).The re-bleeding rate was higher in the propranolol treatment group than in the elderly and non-elderly EVL groups [58.1％ (18/31) vs.24.7％ (24/97) vs,22.9％ (16/70),x2 =14.76,P =0.00].One-year survival rates in the elderly group,the non-elderly EVL group and the propranolol treatment group were 86.6 (84/97),88.6％ (62/70),64.5％ (20/31),respectively,with statistically significant differences between the three groups (x2 =10.24,P=0.01).Conclusions EVL is effective for the treatment of hepatic cirrhosis with EVB and can be used as a secondary prophylaxis measure for EVB in elderly patients with hepatic cirrhosis.

0.05) and systolic velocity of regional myocardium, the difference between Ven and Vep, and mitral valve annulus have improved during the follow up study( P

Objective To observe the cardioprotective effect of ginseng-monkshood extract injection on ischemia-reperfusion injury in rats'isolated working hearts.Methods The heart models of ischemia-reperfusion injury were built by Langendorff isolated heart perfusion technology.The different concentrations of nitrogen saturated Ginseng-monkshood extract injection were used for infusion,and the indexes of heart rate,coronary flow and myocardial enzymes were observed in reperfusion 20 min and 40 min.Results Infusion of ginseng-monkshood extract injection can improved heart rate and flux of coronary artery and inhibit the leak of lactic dehydrogenase and creatine kinase during ischemia reperfusion.Conclusions Ginseng-monkshood extract injection has obviously protective effect on myocardial ischemia reperfusion injury.

Objective To investigate the effect of BQ-123 on the ability of learning and memory and nerve cell autophagy in hippocam-pus in rats with subarachnoid hemorrhage (SAH). Methods 72 male Sprague-Dawley rats were randomly divided into sham group, SAH model group (SAH group) and BQ-123 group with 24 rats in each group. SAH model was established by injecting the autologous blood into cisterna magna twice. The sham group was not injected blood. BQ-123 group received intracerebroventricular injection with BQ-123 18μg 30 minutes before modeling. 6, 24, 72 and 144 hours after modeling, the passive avoidance latency (PAL) and active avoidance reaction rate (AARR) were tested with Shutter Box Test, the nerve cell morphological changes of hippocampus were observed with HE staining, and the expressions of Beclin-1 and LC3-II were detected with immunohistochemical staining. Results Compared with the sham group, the PAL pro-longed, the AARR decreased (P<0.05), the nerve cells in the hippocampus reduced (P<0.05), and the expressions of Beclin-1 and LC3-II in-creased (P<0.05) in SAH group. Compared with SAH group, PAL shortened (P<0.05), AARR increased (P<0.05), the nerve cells in the hip-pocampus increased (P<0.05), and the expressions of Beclin-1 and LC3-II increased (P<0.05) in BQ-123 group. Conclusion BQ-123 can promote the recovery of learning and memory ability, which may relate to the activation of nerve cell autophagy in the hippocampus.

Objective To explore the regulation of PI3K-mTOR signaling pathways on autophagy of hippocampus nerve cells after subarachnoid hemorrhage (SAH)in rats.Methods We randomly divided 72 male Sprague-Dawley rats into sham group,SAH model group and LY294002 group with 24 rats in each group.We established SAH model with the secondary injection of blood method while the sham group was not injected with blood.PI3K signaling pathways specific inhibitor LY294002 was injected with 500μmol per rat 30 minutes before modeling.After 6,24,72 and 144 h morphologic changes of hippocampus CA1 neural cells were observed by microscopy;the expression levels of PI3K,mTOR,Beclin-1 and LC3-Ⅱ were detected by immunohistochemical method.Results The density of survival neurons in the SAH group was significantly lower than that in the control group (P<0.05),PI3K-mTOR signaling pathways were activated obviously,and the expressions of Beclin 1 and LC3-Ⅱ were significantly higher than those in the control group (P<0.05 ).The number of survival neurons significantly decreased in the LY294002 group compared with the SAH group at each time point (P<0.05),PI3K-mTOR signaling pathways were suppressed.The expressions of Beclin-1 and LC3-Ⅱ were significantly lower than those in the SAH group (P<0.05).Conclusion PI3K-mTOR signaling pathways protect neurons by activating the autophagy of neurons after SAH.

Objective To develop a radionuclide parameter database on internal contamination in nuclear emergencies. Methods By researching the radionuclides composition discharged from different nuclear emergencies, the radionuclide parameters were achieved on physical decay, absorption and metabolism in the body from ICRP publications and some other publications. The database on internal contamination for nuclear incidents was developed by using MS Visual Studio 2005 C# and MS Access programming language. Results The radionuclide parameter database on internal contamination in nuclear emergency was established. Conclusions The database may be very convenient for searching radionuclides and radionuclide parameter data discharged from different nuclear emergencies, which wonld be helpful to the monitoring and assessment of internal contamination in nuclear emergencies.

BACKGROUND: Family factor is the main reason for children's psychological and behavioral problems. Seen from the view of systemic family theory, in any circumstances, children's behavioral problems reflect various interpersonal systemic networks among society, school, family, relatives and friends and the relationship of complicated interactions among individuals.Family therapy is an important way to cure children's behavioral problems.OBJECTIVE: To observe whether systemic family rehabilitation is adequate for intervening in children's behavioral problems.DESIGN: Cluster sampling; Contrast observationSETTING: Department of Psychiatry, Kunming Medical College.PARTICIPANTS: A total of 276 students in grade four from Mingtong primary school of Kunming City were selected along with their parents from May 2004 to March 2005. A survey was conducted on students and their parents according to the principle of cluster sampling.METHODS: Self-rating family dynamics scale was used to investigate the characteristics of family dynamics of 276 students in grade four. Achenbach child behavior checklist for parents was adopted to investigate the situation of their children' s behaviors. 57 cases of children with behavioral problems were detected out, and took the families in which the whole family members voluntarily participated in the intervention as interventional group and the families in which any one of the family members did not want to participate in the intervention as abnormal control group. The students and their parents in interventional group were treated with 4-month systemic therapy. 4 months later, resent the above rating scales.MAIN OUTCOME MEASURES: Comparison of family dynamics and children's behaviors between interventional group and abnormal control group before and after intervention.RESULTS: After intervention, changes of family dynamics and children's behaviors in interventional group had taken place, which had statistical difference. The changes as follows: family atmosphere changed from "depressive and hostile" to "harmonious, pleasant, equal and exoteric"; the degree of individuation of family members changed from low level to high; disease concept changed from "regarding the patients as helpless victims" to "regarding them as helpful doers", which realize "softening of disease concept". The total scores of Achenbach child behavior checklist for parents decreased [The scores of questionnaire for fathers before and after intervention were (42.20±22.58) and (28.95±21.90) respectively, and scores of questionnaire for mothers before and after intervention were (50.95±14.60) and (36.40-±15.36) respectively, P ＜ 0.05]. There was no significant difference between the changes of children's behaviors assessed by fathers and mothers in abnormal control group [The scores of questionnaire for fathers before and after intervention were (38.32±17.30) and (37.57±16.45) respectively, and scores of questionnaire for mothers before and after intervention were (45.54±16.02) and (40.14±17.95) respectively, P ＞ 0.05].CONCLUSION: Using the idea and technique of systemic family therapy ,it is feasible and effective to intervene in children's behavioral problems by family therapy.

Objective To summarize the experience of pituitary adenoma resection by single-nostril transsphenoidal approach and analyze the indications,intraoperative and postoperative common problems in order to improve the technique and quality of life.Methods Summarize the clinical data of 611 pituitary adenoma resections by single-nostril transsphenoidal approach from January 2005 to June 2010 retrospectively,reanalyze the choice of operative indications,analyze the bleeding during the operation and sums up the relevant pro cessing suggestions,and summarize the reasons and countermeasures of postoperative visual impairment.Results The tumors were totally removed in 538 cases,sub-resections in 59 cases,sub-totally removed in 14 cases,and no deaths.Eleven cases were poor gasification or concha sphenoid sinus in 11 totally removed patients.The bleeding came from diploe,emissarium,mucosa of sphenoid sinus,diploe,epidural space,dura matter of the sella turcica region,intercavernous sinuses,tumor or the tumor bed.The bleeding was controlled effectively with different approaches.There were 3 patients who underwent visual impairment,and the impairment was improved after treatment.Conclusion Following the correct operation principle,we can improve the rate of total resection; the single-nostril transsphenoidal approach is also suitable for the poor gasification; The prognosis can improve after deal with the intraoperative and postoperative common problems.

Objective To improve the diagnosis and treatment of von H ippel-Lindau (VHL) disease.Methods The clinic data of one kindred with VHL disease type Ⅱ B was reviewed including clinical manifestation,imaging,pathology and therapy.A 40-year-old male complained of the left upper extremity numbness for 6 months,and a variety of visceral tumors were found 3 months ago.Contrast-enhanced MR imaging showed multiple brain tumors.CT showed left kidney tumor,pancreatic tumor,pars-aortic tumor and left adrenal tumor.Fundoscopy showed multiple retinal hemangioblastoma.PET-CT discovered abdominal multiple tumors.And pedigree analysis was to determine the family medical history,and 6 members got genetic screening.Results In the kindred with VHL disease type Ⅱ B,9 members (30％) out of 40members in 4 generations got the disease.Six members got genetic screening,and the result showed 5 (5/6) members had mutation.Three (3/5) members with 3 sites genetic mutation showed clinical manifestation,1 (1/5) members with 3 sites genetic mutation without clinical manifestation found brain tumors by MRI,and 1 ( 1/5 ) member with 1 site genetic mutation did not find disease by comprehensive checkup.The main mutation located at exon 1 in chromosome 3p25 of VHL gene.All mutation was hetcrozygous mutation.The 295,337 and 337 nucleotide thymine of the VHL gene were substituted by cytosine,cytosine and adenine,which made the 98th,112th and 112th tyrosine substituted by histidine and asparagines.One member with 1 site mutation had 98th tyrosine substituted by cytosine.The first operation was to remove brain tumor,and the second operation was to remove adrenal tumor,para-aortic tumor and renal tumor.Pathology of the brain tumors showed hemangioblastoma,and the retroperitoneal tumors were clear cell carcinoma,paraganglioma and pheochromocytoma.Followed up for 6 months after operation,no relapse occurred.Conclusions VHL disease is a relatively rare autosomal dominant disorder.Comprehensive management of patients should also include genetic counseling and screening for other manifestations of the disease process.Genetic testing might be helpful in early detection of asymptomatic VHL patients.Members having gene mutation should be followed up strictly.Surgical management of VHL disease should be decided on the base of comprehensive assess.Multiple lesions could be cut off in one operation.For patients with pheochromocytoma,pheochromocytoma shuld be handled first.