Objective To investigate the risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) .Methods 181 cases of patients after TIPS diagnosed in this department from January 2009 to December 2013 were reviewed .The patients were divided into two groups:42 cases with hepatic encephalopathy (HE group)and 139 cases without he-patic encephalopathy(control group) .To evaluate the possible risk factors such as age ,sex ,pathogeny of cirrhosis ,complications [(Child-Pugh score ,portal pressure gradient (PPG ) ,Child-Pugh grading ,fibrinogen ,hemoglobin ,serum natrium ] were recorded and analyzed .Unconditional logistic regression model(W ald test)was used to screen the independent risk factors .Receiver operating characteristic curve was plotted and the area under it was calculated to evaluate the diagnose performance .Results There was no significant statistical difference between HE group and control group about age ,sex and pathogeny of cirrhosis(P>0 .05) .Analysis of unconditional logistic regression model indicated that Child-Pugh score ,PPG ,Child-Pugh grading ,were single risk factors of HE after operation(OR=1 .29 ,1 .06 ,1 .22) ,while fibrinogen ,hemoglobin and serum natrium were protective factors .ROC curve was plotted and the AUC was calculated to evaluate the diagnose performance ,which indicated the sequence was that ,Child-Pugh score> PPG>Child-Pugh grading>hemoglobin>fibrinogen>serum natrium .Conclusion Child-Pugh score ,PPG ,Child-Pugh grading , fibrinogen ,hemoglobin and serum natrium were single hazard factors of HE after operation .

Carcinoma, Hepatocellular ; Hepatitis B virus ; Humans ; Liver Neoplasms ; MicroRNAs ; Trans-Activators

Objective By using immunohistochemical staining of neuropeptide Y (NPY) and fluorescence of ethylaldehyde acid-induced biomonoamine mediators, to observe the distribution of sympathetic nerve terminals in human cervical capsule tissues, and to compare the two methods for further improvement. Methods Surgically removed joint capsule tissues from C 3~7 vertebrae of 17 cases were treated by paraffin imbedding with NPY immunohistochemical staining and frozen-section with fluorescence staining of ethylaldehyde acid-induced biomonoamine mediators. Slides were preconditioned by 1% KMnO4 and sections 15~20 ?m in thickness were made. The staining was conducted at 100 ℃ for 5 min firstly, and then at 80 ℃ for 2 min. We utilized adrenal glands of rats as positive control. The samples were observed under fluorescence microscope at 380~420 nm excitation wavelengths from a high-voltage mercury light source. Results NPY immunostaining findings indicated bulky positive materials in some arteriolar walls and nerve tracts of the joint capsules; biomonoamine mediators gave off fluorescence in green-yellow color under the induction of ethylaldehyde acid, which presented mostly as reticular or radial finely-broken fibers in vascular walls, basal laminae of the synovial membrane and dense connective tissues. The positive rates of NPY immunohistochemical staining were 70.6% (12/17) at C 3~4 intervertebral segment, 42.9% (6/14) at C 4~5 , 57.1% (8/14) at C 5~6 , and 50.0% (5/10) at C 6~7 , respectively, the total positive rate being 56.4% (31/55). When using the ethylaldehyde acid-induced biomonoamine fluorescence, the positive rates were 70.6% (12/17) at C 3~4 intervertebral segment, 93.8% (15/16) at C 4~5 , 66.7% (10/15) at C 5~6 , and 80.0% (8/10) at C 6~7 , respectively, the total positive rate being 77.6% (45/58). The positive rate was remarkably higher in ethylaldehyde acid-induced biomonoamine fluorescence than in NPY immunohistochemical staining, with statistically significant difference (?2=5.774,P=0016), especially at C 4~5 intervertebral segment (P=0.004). Conclusions Both the two methods can demonstrate the distribution of sympathetic nerve terminals, suggesting the presence of the terminals in human cervical capsule tissues. Modified ethylaldehyde acid-induced biomonoamine fluorescence offers a greater specificity.

BACKGROUND:Hepatic vascular exclusion is important for liver transplantation that can reduce blood loss and make for liver recovery. A variety of favorable hepatic vascular exclusion techniques occur in the development of liver surgery technology, which is stil a research hot in surgical study. OBJECTIVE:To introduce the latest research and the hot spot of hepatic vascular exclusion techniques. METHODS:A computer-based online search of PubMed and Wanfang databases for articles relevant to Pringle maneuve, total hepatic vascular exclusion, selective hepatic vascular exclusion and sectional vascular exclusion under hepatectomy published from January 1999 to January 2014. Totaly 50 articles were included in result analysis. RESULTS AND CONCLUSION:There are a variety of hepatic vascular exclusion technologies, and intermittent hepatic vascular occlusion and semihepatic vascular exclusion are used most commonly. The applicable principles are as folows: (1) Surgery without vascular exclusion is suitable for < 5 cm lesions at the liver edge. (2) Semi-hepatic vascular exclusion is fit for semi-hepatic lesions, especialy for patients accompanied by liver cirrhosis. Hepatic vascular exclusion with preservation of semi-hepatic artery and liver hanging maneuver are also reported to have a certain value in clinical practice stil need further studies. (3) Intermittent hepatic vascular exclusion is suitable for lesions over half a liver or spanning liver halves (huge lesions). (4) Total hepatic vascular exclusion and its modified technologies are suitable for lesions involving the inferior vena cava and (or) hepatic vein, or lesions closely related to the second and third porta hepatis. (5) Segmental hepatic vascular exclusion is considered for smaler lesions confined to the liver segment under alowed conditions, but semi-hepatic vascular exclusion and Pringle maneuver can be also considered. Depending on patient’s conditions, to select the appropriate method is the key to reduce bleeding and to ensure patient safety.

9scores). Results Fifty-five of fifty-seven cases with CT between 0～6 scores,which considered to be resected,underwent tumor resection . The accuracy of prediction of CT was 96.5%. Conclusions Preoperative CT scord could accurately predict the resectability and difficulty of pancreatic cancer.

[Objective]To evaluate the outcome of thoracolumbar fracture with spinal cord injury treated with short-segment pedicle instrumentation.[Method]47 cases of thoracolumbar fracture with spinal cord injury from 1999 to 2004 in our department were collected,all of them were treated with short-segment pedicle instrumentation.The radiologic,neurologic,and functional outcome were assessed.[Result]All of the 47 cases were followed up,the mean follow-up were 51.9 months(18~ 86 months),the average of vertebral anterior and posterior height were corrected from 43.6%,71.4% to 92.2%,96.4%;and 88.3%,93.1% at the last follow-up separately.The Cobb's angle were corrected from 23.5?to 4.3?,and 8.8? at the last follow-up.62.8% of the vertebral canal was occupied pre-operation,and 11.4% post-operation,6.2% at last follow-up.There was significant deference in targets between pre-operation and post-operation(P0.05).Neurologic status improved at least 1 Frankel grade in the patients who had preoperative incomplete paraplegia.61.7% of patients returned to work.[Conclusion]Short-segment pedicle instrumentation can provide good reduction,strong fixation,complete decompression and fusion.The treatment outcome is good.Moreover,it is a less traumatic,simple and safe technique.

0.05). Nine foots (18.0% ) reported soft tissue problems in the plate group, and three foots (5.5% ) in the limited internal fixation group. The difference between the two groups was statistically significant (P

Objective To establish an RP-HPLC method for the determination of the content of safflor yellow A in Zhanjing Tinctura. Methods The chromatographic procedure was carried out in Symmetry C18 column(4.6mm?150 mm,5.0?m)with methanol-water-glacial acetic acid(7:93∶2)as the mobile phase,pH=2.80. The flow rate was 1.0 mL?min-1,column temperature was 20℃,and the detection wavelength was 402 nm. Results Safflor yellow A was well separated from other components. The standard curves of safflor yellow A showed linearity in the range of 0.096～0.960?g (r=0.9999). The average recovery was 98.80% with RSD being 2.95%(n=9). Conclusion This method is sensitive,simple and accurate,and can be used for the determination of safflor yellow A in Zhanjing Tinctura.

Objective To establish a HPLC method for the determination of the content of emodin and chrysophanol in Cigu Xiaozhi pill.Methods The chromatographic procedure was carried out in Symmetry C18(4.6 mm?150 mm,5.0 ?m) column with methanol-0.1% phosphoric acid(85∶15) as the mobile phase,flow rate was 0.8 mL/min,column temperature was 20 ?C,and the detection wavelength was 423 nm.Results Emodin and chrysophanol were well separated with other components.The standard curves of emodin and chrysophanol showed linearity in the range of 0.25～0.75 ?g.The average recoveries were 101.35%(RSD=2.26%) and 98.66%(RSD=1.74%) respectively.Conclusion The method is sensitive,simple and accurate,and can be used for the determination of emodin and chrysophanol in Cigu Xiaozhi pill.

Objective To assess the efficiency and safety of alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP).Methods The electronic databases of PubMed,EMBASE,Cochrane Library,Web of Science,Chinese BioMedical Literature Database (CBM) and Wanfang Data were searched for all randomized controlled trials (RCT) of alendronate vs.placebo.Two reviewers independently selected trials for inclusion,assessed trial quality using Jadad's scale and extracted the data.RevMan 5.1 software was used for data synthesis and Meta-analysis.Results Seven studies with 1111 patients were included.Compared with placebo,alendronate significantly increased bone mineral density (BMD) at the lumbar spine[MD ＝3.35,95％CI (2.67-4.02),P =0.000] and the femoral neck[MD =1.90,95％ CI (0.89-2.92),P =0.000] after 12 months of therapy.After 24 months of therapy,alendronate significantly increascd BMD at the lumbar spine [MD =3.91,95％ CI (2.37-5.45),P =0.000],but not at the femoral neck [MD =1.91,95％ CI (-1.15-5.02),P =0.22].Compared with placebo,no significant reduction was found by the use of alendronate in the incidence of vertebral fractures [RR =1.00,95％ CI (0.49-2.07),P =0.99] or nonvertebral fractures[RR ＝ 1.02,95％ CI (0.49-2.14),P =0.95].No difference was shown with the adverse event between the two groups[RR =0.97,95％ CI (0.90-1.05),P =0.47].Conclusions Alendronate is effective for the prevention and treatment of glucocorticoid-induced bone loss at the lumbar spine and the femoral neck with relatively good safety profile.Yet,there is no significant difference between the two groups in reducing the incidence of vertebral fractures and non-vertebral fractures.Large-scale RCT designed to observe whether different lengths of alendronate therapy will influence the efficiency should be conducted in the future and to further explore whether it can reduce the incidence of fractures.