Objective To investigate the predictive value of the baseline ,week 1 and week 2 model for end‐stage liver disease (MELD) scores ,MELD‐Na scores and MELDNa scores for 3‐month mortality in hepatitis B virus (HBV) related acute‐on‐chronic liver failure (ACLF) patients .Methods Fifty‐three eligible HBV‐related ACLF patients who received initial treatment in People′s Hospital of Deyang City , Sichuan Province from January 2014 to January 2015 were enrolled in this retrospective clinical follow‐up study .Patients were divided into death group and survival group according to the prognosis after 3 months of treatment .Biochemical data and complications were collected .t test was used to compare the means between two groups and χ2 test was used to compare categorical data .Accuracy of scoring models in predicting mortality within 3 months was performed by area under receiver operating characteristic curve (AUC) .Results Of the fifty‐three patients ,twenty‐one HBV‐related ACLF patients died in 3‐month , while thirty‐two patients survived .The AUC of MELD scores ,MELD‐Na scores and MELDNa scores at the baseline in predicting 3‐month mortality were 0 .548 (95% CI:0 .406 -0 .685 , P= 0 .555) ,0 .502 (95% CI:0 .362-0 .643 ,P=0 .978) and 0 .523 (95% CI:0 .381-0 .662 ,P=0 .778) ,respectively .The AUC increased gradually at the first and the second week .At the second week ,the AUC of MELD scores ,MELD‐Na scores and MELDNa scores were 0 .881 (95% CI:0 .762 -0 .953 ,P<0 .01) ,0 .878 (95% CI:0 .759-0 .951 ,P<0 .01) and 0 .897 (95% CI:0 .783 -0 .963 ,P<0 .01) ,respectively .The AUC of the second week was higher than those of the baseline and the first week (both P<0 .05) .The sensitivity ,specificity ,positive predictive value (PPV) ,and accuracy at the second week were best when the cut off was 26 for MELD ,29 for MELD‐Na and 29 for MELDNa , and were higher than the corresponding values of the baseline and the first week .Conclusions The predictive values of MELD scores ,MELD‐Na scores and MELDNa scores at the second week are superior to the baseline and the first week for 3‐month mortality in HBV‐related ACLF patients ,while the predictive values at the baseline could be poor .

Objective To observe the effect of 6% hydroxyethylstarch (130/0.4) on hemorheology in patients with acute myocardial infarction (AMI) complicated by shock before and after early fluid resuscitation. Methods 72 AMI patients complicated by shock were randomly divided into two groups , namely groupⅠwith 6%hydroxyethylstarch (130/0.4) for early liquid resuscitation and group Ⅱwith balanced salt (1.86% sodium lactate solution and compound sodium chloride solution for a ratio of 1∶2 ) for liquid recovery; and another 36 subjects was assigned to normal control group (groupⅢ). The hemorheological indices were detected after admission and 2 to 3 hours after fluid resuscitation in groupsⅠandⅡ. Results After fluid resuscitation , high-and low-shear viscosity , red cell aggregation index, hematocrit, fibrinogen, and platelet aggregation rate decreased in groupⅠand groupⅡ, with significant statistical differences (P < 0.05 and P < 0.01). Conclusions 6% hydroxyethylstarch (130/0.4) can effectively improve abnormal hemorheology in patients with AMI complicated by shock.

Objective To study the effects of dendritic cells (DC) modified with transforming growth factor ?1 (TGF-?1) gene on experimental autoimmune myasthenia gravis (EAMG) in Lewis rats. Methods 30 female Lewis rats were divided randomly into 6 groups: normal group, EAMG group, DCs treatment group, pcDNA_3-TGF-?1-DCs treatment group, pcDNA_3-DCs treatment group and normal saline group. The rats were immunized with the acetylcholine receptor (AChR) protein extracted from electric organ of Narcine timilei and completed Freund’s adjuvant (CFA) in the experiment groups except normal group. 2?106 pcDNA_3-TGF-?1-DCs/rat were injected subcutaneously into the backs of the rats that had been immunized 5 days earlier with AChR+CFA. The rats in DCs treatment group, pcDNA_3-DCs treatment group and normal saline group were injected in parallel with untreated DCs, pcDNA_3-DCs and normal saline respectively. Then the clinical manifestations were observed everyday. And 7 weeks after the first immunization, repetitive nerve stimulation, detection of acetylcholine receptor antibody (AChRab) and ultrastructural study of neuromuscular junction (NMJ) were performed. Results (1) The mild symptoms were observed on 1 or 2 rats in the experiment groups except normal group after a week, which lasted for 2 to 5 days. After about 5 weeks, the rats in EAMG group, DCs treatment group, pcDNA_3-DCs treatment group and normal saline group presented some symptoms at different degree like myasthenia gravis, and only one of the rats in pcDNA_3-TGF-?1-DCs treatment group presented mildly decreased activity. (2) The significant decrement of repetitive nerve stimulation were found in EAMG group, DCs treatment group, pcDNA_3-DCs treatment group and normal saline group(16.75?6.13, 17.75?7.81, 18.25?8.22 and 16.50?7.14, respectively), but there was no attenuation in pcDNA_3-TGF-?1-DCs treatment group and normal group(3.20?3.70 and 5.60?2.70, respectively). The percentage of decrement in pcDNA_3-TGF-?1-DCs treatment group was lower than that in EAMG group(5.60?2.70 and 16.75?6.13, respectively,P0.05). (4) The combined AChRs in NMJ of the rats in pcDNA_3-TGF-?1-DCs group were higher than that in EAMG group, and the structure changes of the synapse were relieved.Conclusion It suggests that DCs, transfected with pcDNA_3-TGF-?1, when injected subcutaneously into Lewis rats with incipient EAMG, could inhibit the production of AChR-Ab, relieve the pathologic changes in NMJ and ameliorate the development of EAMG.

Objective To summarize the nursing experiences of patients who have received liver transplantation. Method Through the analysis 3 forms of preoperative nursing care and 6 forms postoperative nursing care methods of two cases of patients who have received liver transplantation, the important point and method of nursing care was made out. Result There were no complications were found, and the two cases were fully recovered and discharge from the hospital. Conclusion Sufficient preoperative preparation, earlier period vital sign monitoring,proper using of immunosuppressive agent,protecting complication protection, diet guidance, proper activity and resting, were the keys for the success of liver transplantation.

Objective To investigate the susceptible gene loci of SLE.Methods Susceptible loci of chromosome16were found in systemic lupus erythematosus(SLE).According to our previous linkage map-ping and gene chip data,four genes named OAZ,CARD15,DNAJA2and IL-4R were chosen as candidate genes for gene expression research.mRNA extracted from whole blood of42SLE patients and36normal controls were reversely transcipted to cDNA.Then Taqman probe and primers were added to perform real-time PCR in ABI Prism誖7900HT sequence detection system.Housekeeping gene GAPDH was used as a control.Results OAZ and CARD15gene expression was significantly higher in SLE patients than those in normal controls(P

Objective:To explore the efficacy of group cognitive-behavioral therapy (GCBT) to generalized anxiety disorder (GAD).Methods:In this randomized controlled trial,the control group (n =23) and the intervention group (n =33) were included,all of the participants received duloxetine (30-120 mg/d) as pharmacotherapy.The intervention group received 8 group cognitive-behavioral therapy sessions weekly,90 minutes for each time.Assessments were conducted with the Hamilton Anxiety Scale (HAMA),Hamilton Depression Scale (HMAD) and Clinical Global Impression (CGI) at baseline,mid-treatmentand post-treatment.CGI included three factors,the severity of illness (SI),the globalimprovement (GI) and the efficacy index (EI).Results:The repeated measures analysis of variance of HAMA showed that,there were statistical significance on the HAMA for interaction between measure time and group processing (F =4.35,P ＜ 0.05).Compared with the control group,the intervention group got higher decreased scores of HAMA at the 4th week and 8th week,and higher prevalence of being cured and efficient at the 4th week.At the 8th week,the decreased scores of HMAD were higher in the intervention group than in the control group,and the scores of CGI-SI and the CGI-IE were lower in the intervention group.Conclusion:It suggests that group cognitive-behavioral therapy combined with pharmacotherapy could be earlier to be effective,and the symptoms of anxiety,depression and the state of illness could be improved more significantly compared with pharmacotherapy alone.

Objective To further investigate clinical manifestations and management for thallium poisoning. Methods Clinical data of 6 patients who were hospitalized in Union Hospital of Tongji Medical College in May 2008 with diagnosis of acute or chronic thallium poisoning,were retrospectively analyzed.Results Six patients (4 male and 2 female) ,aged from 12 to 50,came from one family (two sisters with their husbands and sons). Five of them (3 acute and 2 chronic,for the second time in half a year,thallium poisoning) initiated with peripheral neuritis,represented with severe burning pain,numbness,paresthesia in the lower limbs,accompanied with or without gastrointestinal symptoms. A 12 year-old boy with obviously elevated urinary thallium concentration was asymptomatic. Blood and urinary thallium concentrations of the patients were determined by atomic absorption spectrophotometry and were all significantly elevated.Treatment was initiated using potassium supplementation,diuresis,oral laxatives,Prussian blue and intramuscular injection of dimercaptopropansulfonate sodium.Meanwhile two of them were treated with hemoperfusion. Finally,two of them recovered,another two were transferred to a specialized hospital for continuous treatment,and the rest two deteriorated rapidly with occurrence of unconsciousness and died of multiple organ failure. Conclusions The main clinical manifestations of thallium poisoning are multiple peripheral neuritis,gastrointestinal symptoms and dermatological changes. In order to avoid missed diagnosis and misdiagnosis,a high suspicion should be arose for thallium poisoning when a patient suffering from the above symptoms.Prussian blue was considered traditionally as an effective therapeutic strategy for the condition,and hemoperfusion may be a more effective treatment for acute thallium poisoning.

Objective:To explore whether sera from patients with systemic lupus erythematosus affect the senescence of MSCs, and which signaling pathway might be involved in.Methods: Human sera were collected from sex-matched,age-matched active SLE patients (n=6) and healthy volunteers (n=6).Then the complement was inactivated at 56℃ for 30 min.MSCs were cultured in DMEM/F12 containing 10% SLE or normal serum.Three days later MSCs were stained with SA-β-gal.The percentages of SA-β-gal positive cells were evaluated.The mRNA levels of p53 and p21 were detected by Real time PCR.The protein levels of p53/p21 and NF-κB ( p65) were examined by Western blot.Cell proliferation was evaluated by CCK8 assay.Results: Compared with normal serum, MSCs from either healthy controls or SLE patients showed more SA-β-gal positive cells in SLE serum,as well as higher levels of p53/p21.In addition,SLE serum also inhibited the capacity of MSC proliferation.In MSCs treated with SLE serum, the level of NF-κB (p65) protein was significantly upregulated.Conclusion:SLE serum can promote the senescence of bone marrow MSCs,which might be mediated by NF-κB signaling pathway.

Gas gangrene is an emergency condition, which usually develops after injuries or surgery. This study was designed to investigate clinical characteristics, appropriate therapy, and effective control of nosocomial cross-infection of gas gangrene in Wenchuan earthquake victims. Data on diagnosis, treatment, and prevention of confirmed, suspected, or highly suspected gas gangrene were collected. Sixty-seven (2.41%) cases of suspected gas gangrene were found, in which 32 cases were highly suspected of gas gangrene and 5 cases were confirmed by culture of Clostridium perfringens. Thereof, injury sites were mainly located on the limbs, and typical indications, including crepitation, severe localized pain, swelling, wound discoloration, dark red or black necrotic muscle, foul smell as well as different degrees of systemic toxic performance were common among them. After hospitalization, all patients were isolated and had surgery quickly to remove dead, damaged or infected tissue. The wounds were also exposed for drainage and washed or padded with 3% liquid hydrogen peroxide for disinfection before all diagnostic test results were available. Additionally, high doses of antibiotics (mainly penicillin) were given for the prevention of infection, and supportive therapy was applied for corresponding symptoms control. Among those cases, no fatality was reported. In summary, in post-disaster emergency relief, the diagnosis of gas gangrene should be primarily based on clinical manifestations; while patient isolation, wound debridement and disinfection, as well as antibiotics treatment, is the main measures for proper treatment and control of nosocomial infection for gas gangrene.

Objective To compare the diagnostic value of DWI and ultrasound elastography(UE) in staging hepatic fibrosis in patients with chronic viral hepatitis B(CHB). Methods Fifteen healthy volunteers (control group) and 69 patients with CHB (disease duration more than 1 year) (patient group) were prospectively recruited. All of the subjects underwent DWI and UE experiments twice with the interval of less than 3 days. Liver ADC and shear wave velocity(SWV) values were obtained for subsequent analysis. Sixty?nine patients who had biopsy were grouped according to their pathological grading of fibrosis, from S0 to S4. One?way ANOVA was used to compare the ADC and SWV values between the five different fibrosis groups and control group. Spearman correlation analysis was used to analyze the correlations between the ADC and SWV values and those staging factors. Finally, receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic performance of ADC and SWV values in discriminating different stages of hepatic fibrosis. Results Based on the pathological results, the 69 patients were reclassified to five subgroups with 11, 13, 12, 15 and 18 patients in the S0, S1, S2, S3 and S4 groups respectively. ADC values were(1.39±0.09)×10-3,(1.39±0.08)×10-3,(1.38±0.10)×10-3,(1.20±0.06)×10-3,(1.12±0.07)×10-3 and(1.01±0.07)×10-3mm2/s for the control group and stages S0 to S4 respectively.SWV values were(1.17±0.07),(1.16±0.08),(1.23±0.10),(1.48±0.14),(1.85±0.14)and(1.97±0.12)m/s for stages S0 to S4 and the control group respectively. Statistically significant differences were observed among them (P<0.01). Both ADC (r=-0.894,P<0.01) and SWV (r=0.904,P<0.01) values were highly correlated with the stages of liver fibrosis. The area under ROC(AUC) for predicting fibrosis stages (≥S1, ≥S2, ≥S3 and S4) with ADC values was 0.893, 0.991, 0.966 and 0.952 respectively. Accordingly, the AUC for SWV values were 0.937, 0.993, 0.994 and 0.914. Conclusions The two imaging methods of DWI and UE showed good and similar diagnostic performance in discriminating the different stages of hepatic fibrosis.