This study was to evaluate the feasibility of hepatectomy for primary liver cancer (PLC) without hepatic blood flow occlusion. Methods 194 PLC patients admitted between 1988～1998 underwent hepatectomy without hepatic blood flow occlusion including nonanatomical hepatectomy (100 cases),hepatolobectomy (41 cases), combined adjacent organ resection (30 cases), hepatic segmentectomy (22 cases) and left hemihepatectomy (3 cases). Results Operative time was 2 4 hr, intraoperative blood transfusion averaged at 649 ml. Operative complication rate was 18 0%, and there was no mortality. Conclusion Hepatectomy without hepatic blood flow occlusion for PLC patients can be performed safely, so it is a useful technique for hepatectomy.

Objective To explore the relationship between angiotensin I-converting enzyme(ACE)gene I/D and angiotensin Ⅱ type 1 receptor(AT1R)gene A1166C polymorphisms and cereral infarction(CI).Methods ACE and AT1R genotypes were investigated with the method of PCR-RLFP in 88 patients with CI and compared with 90 age-matched population controls.Results AC genotypic frequency(31.8%)and C allele frequency(15.9%)of AT1R gene in CI group were significently higher than those in control group(11.1%,5.6%)(all P0.05).Conclusions The polymorphism of AT1R A1166C is related to the incidence of CI.There are synergistic effects of ACE DD genotype and AT1R gene A1166C polymorphisms on the risk of CI.

Objective To explore the relationship between angiotensin Ⅱ type 1 receptor (AT1R) gene polymorphisms and cerebrovascular disease (CVD).Methods The 104 patients with CVD and 98 healthy individuals were detected the AT1R genotypes polymorphisms by restriction fragment length polymorphism in order to analysis.Results CC genotype was not found both in CVD and control group. In CVD group, genotypic frequency of AA was 40.4% and AC was 59.6%. The allele frequency of A was 70.1% and C was 29.9%. In control group, genotypic frequency of AA was 91.8% and AC was 8.1%. The allele frequency of A was 95.9% and C was 4.1%. AT1R polymorphism revealed there was significant difference between the genotype and allelic distribution in CVD patients and those of in controls (all P

Limited Price Charge for Single Disease means that hospitals limit price for the patient who has only single disease in the diagnosis and treats process. The charge includes the process from the time when he had been diagnosed and been in hospital to the time when he had been charmed off. Limited Price Charge for Single Disease could solve many ethical problems which exist in current medicine realm, so it means too much in Medical Ethics, and it gives Hospital Administration and Health Care Administration new inspiration.

As a new service model,clinical pathway has been applied in many areas.But there is no study on it from prospective of medical ethics.The author holds that the clinical pathway can enhance help achieving the objective of serving people's health,implementing the principle of informed consent,embody the human-center thinking,and eventually realize the goal of justice.

Objective To evaluate the clinical effect of immediate implant restoration in lower posterior teeth . Methods 31 XIVE implants were placed in lower posterior teeth of 31 patients.The temporary fixed resin crowns were fabricated immediately and final restorations were finished in 3~4 months.The control group used nonsub-merged implants and were restored with final crowns in 3~4 months.The tracking survey was taken from 12 to 24 months after final restoration .The patient satisfaction , papilla index score ( PIS ) and implant survival rate were eval-uated between the two groups .Results PIS of patients with immediate restoration reached (2.35 ±0.70) in aver-age compared(1.84 ±0.74) in control group.The patient satisfaction reached (91.5 ±7.5) with immediate resto-ration, compared with VAS score in average of(85.8 ±8.1) in control group.All implants in both groups achieved osseointegration and received 100% survival rate .Conclusion With proper technique in surgical and restoration procedure , immediate restoration after implant insertion in posterior madible has similar clinical success compared with delayed restoration .

Objective To investigate the features of patients with cyclic citrullinated peptide (CCP) antibodies in primary Sj(o)gren's syndrome (pSS) with the retrospective method.Methods Seventy eight pSS patients were studied.Enzyme-linked immunosorbent assay (ELISA) indirect immunofluorescence was used to measure anti-CCP antibodies.The patients with and without anti-CCP antibodies were correspondingly classified as autoantibody-positive and negative pSS groups.Clinical and laboratory features were compared between autoantibody-negative and positive group.Results (1) Seven (9.0％) of pSS patients had positive anti-CCP antibody.No significant difference was found in sex,ages,and disease course between autoantibody-nagative and positive pSS patients.(2) The anti-CCP-positive pSS was associated with the rates of decayed tooth,fatigue,dry mouth,dry eyes,and tender of joint (P ＜ 0.05).Whereas,the antiCCP-negative pSS was not significantly related to fever and mumps (P ＞ 0.05).(3)From serologic characteristics aspects,the anti-CCP-positive patients showed higher level of tender of joint than the anti-CCP-negative patients.No significant difference was found in white blood cell (WBC),hemoglobin (HGB),platelet (PLT),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),immunoglobulin A (IgA),IgG,IgM,and rheumatoid factor (RF) between two groups (P ＞ 0.05).Conclusions The anti-CCP-positive patients were 9％ ofpSS patients,and were more likely to occur tender of joint with higher level of tender of joint.

Objective To analyze acinetobacter Baumanii infections in ICU and explore the nursing strategies.Method The clinical data of 5310 ICU patients infected with acinetobacter Baumanii in our hospital were retrospectively analyzed.Results Among the 5310 patients in the ICU,26 were infected by acinetobacter baumanii with an incidence of 0.5%,with 46.2%patients contracted cerebral hemorrhage,38.5%intracerebral tumor,92.3%infection by multi-drug resistant bacteria and.All patients were managed with artificial ventilation and 84.6%patients were hospitalized in ICU for over 7 days.Conclusions The nursing strategies includes reasonable use of antibiotics,active treatment of primary diseases,rigid control of disinfection and isolation,attaching importance to hand hygiene and strict implementation of nursing practice,which are important for preventing and controling the infection of acinetobacter baumanii.

Objective To investigate the detection rate of anti-SSA60 and SSB antibodies in sera of patients with systemic lupus erythematosus (SLE).The correlation of anti-SSA and SSB antibodies with SLE clinical outcome was also investigated.Methods This study included 251 cases of SLE diagnosed in our hospital between 2007 and 2010.ELISA and double immunodiffusion method was used to detect the sera antiSSA60 and SSB antibodies.The patients were closely monitored for three years in terms of clinical and laboratory parameters and the presence of associated Sj(o)gren' s syndrome (SS).Statistical analysis were performed using student t test or x2 test.Results ① The detection rate of anti-SSA60 antibody in serum of patients with SLE was 65.3％.The detection rate of anti-SSB antibody in serum of patients with SLE was 28.3％; ② During the three-year follow up,patients with anti-SSA60 (29.3％,48 cases) or SSB antibodies (35.2％,25 cases) were more likely to have dry mouth and eyes and later developed SS (P＜0.05); ③ Patients with anti-SSA60 antibody were more likely to develop serositis (20.7％ vs 8.0％),neuropsychiatric lupus erythematosus (NPLE)(18.9％ vs 8.0％),and hematuria (35.4％ vs 21.8％)(P＜0.05).Patients with negative anti-SSB antibody were more likely to have fever (43.7％ vs 57.8％,x2=4.082,P＜0.05); ④ Patients positive for anti-SSB antibody were also positive for anti-Sm antibody (50.7％ vs 32.8％,x2=6.956,P＜0.05);⑤ Younger patients were more likely to have anti-SSA60 and SSB antibodies in their sera (P＜0.05); ⑥Patients positive for anti-SSA60 antibody had higher SLE disease activity index (SLEDAI) than patients with negative anti-SSA60 antibody [(17±9) vs (15±7),t=2.389,P＜0.05].Patients positive for anti-SSB antibody had higher level of IgG [(18±7) vs (16±6) g/L,t=2.304,P=0.023],and lower level of CRP than patients negative for anti-SSB antibody [(14±20) vs (21±33) mg/L,t=-2.173,P=0.031].Conclusion Patients positive for anti-SSA60 antibody have higher SLEDAI and more severe clinical outcomes.Patients with antiSSA or anti-SSB antibody are more likely to develop dry mouth and eyes which eventually leads to SS.

Objective:To observe the effect of CD40 siRNA on expression of IFN-γ,IL-17,IL-4 and anti-dsDNA antibody of systemic lupus erythematosus (SLE)animal model MRL/Lpr mice and to discuss its therapy on MRL/Lpr mice.Methods:In the study,16 female MRL/Lpr mice were randomly divided into control group (n =4),empty vector group (n =4),CD40-siRNA1 group (n =4)and CD40-siR-NA2 group (n =4).The vectors expressing siRNA against CD40 were injected by tail veil into MRL/Lpr mice,while MRL/Lpr mice in control group and empty vector group were injected with the same dose of PBS and pGFP-V-RS vector respectively.The injection was given six times and every one day.The mice were sacrificed 14 d after injection,and the spleen tissue was weighed.The pGFP-V-RS was labeled by green fluorescent protein(GFP)and the tissue sections were observed whether siRNA expressed in the spleen.The expression levels of IFN-γ,IL-17,IL-4 and anti-dsDNA antibody in the sera were detected by ELISA method on the 1st day before the first time and the 2nd,5th,8th,11th,and 14th days after last injection,and the expression levels of CD40 mRNA in spleen tissue of MRL/Lpr mice were detected by RT-PCR and the expression levels of CD40 protein in spleen tissue of MRL/Lpr mice were detected by immunohistochemistry method.Results:The expression vector of CD40-siRNA could express in the spleen of MRL/Lpr.The spleens in CD40-siRNA1 group [(78.85 ±5.61 )mg]and CD40-siRNA2 group [(80.25 ±4.07)mg]were lower than those in control [(141.88 ±7.81)mg]and empty vector group [(153.10 ±7.60)mg].The levels of IL-17,IFN-γand anti-dsDNA antibody were lower and the levels of IL-4 was higher in CD40-siRNA1 group and CD40-siRNA2 group on the 2nd,5th and 8th days after last injection than on the 1st day before the first time (P <0.05).The levels of IFN-γin CD40-siRNA1 group were (118.74 ±10.32)ng/L,(115.24 ±8.26)ng/L and (113.71 ±5.02)ng/L in turn,the levels of IFN-γin CD40-siRNA2 group were (117.83 ±6.83)ng/L,(114.07 ±0.97)ng/L and (112.67 ±9.66)ng/L in turn.The levels of IL-17 in CD40-siRNA1 group were (7.05 ±0.41 ) ng/L,(6.34 ±0.76)ng/L and (5.83 ±0.43)ng/L in turn,the levels of IL-17 in CD40-siRNA2 group were (7.07 ±0.22)ng/L,(6.35 ±0.49)ng/L and (6.12 ±0.80)ng/L in turn.The levels of anti-dsDNA antibody in CD40-siRNA1 group were (7.51 ±0.29 )ng/L,(6.74 ±0.45 )ng/L and (6.32 ±0.39)ng/L in turn,the levels of anti-dsDNA antibody in CD40-siRNA2 group were (8.19 ± 0.38)ng/L,(7.14 ±0.50)ng/L and (6.48 ±0.29)ng/L in turn.The levels of IL-4 in CD40-siRNA1 group were (26.51 ±1.81)ng/L (27.80 ±1.72)ng/L and (28.08 ±2.21)ng/L in turn,the level of IL-4 in CD40-siRNA2 group were (26.28 ±2.03)ng/L,(28.15 ±2.95)ng/L and (28.37 ± 1.71)ng/L in turn.The expression levels of IL-17 and IFN-γantibody increased gradually and the levels of IL-4 decreased gradually in CD40-siRNA1 group and CD40-siRNA2 group on the 11th and 14th days after last injection,then reached to the levels of control group and empty vector group (P >0.05). Though the levels of anti-dsDNA antibody in CD40-siRNA1 group and CD40-siRNA2 group on the 11th day was higher than on the 8th day,there was more significance than those in control group and empty vector group (P <0.05).There was no significance between the 4 groups on the 14th day.The levels of CD40 mRNA and protein were lower in CD40-siRNA1 group and CD40-siRNA2 group than in control group and empty vector group on the 14th day after last injection (P <0.05).Conclusion:CD-40 si-RNA can reduce the concentration of IL-17,IFN-γand of anti-dsDNA antibody in serum,and at the same time,it can elevate the concentration of IL-4 and suppress CD40 mRNA and protein of spleen in MRL/Lpr.Meanwhile after suppressing CD40 mRNA and protein,it can reduce inflammatory response of the mice and the disease activity of MRL/Lpr,suggesting that CD-40 siRNA has therapy effect on SLE.