Objective To investigate the risk factors of postoperative infectious complications (PIC) after liver resection for hepatocellular carcinoma (HCC) using evidence based medicine to provide a basis for prediction and prevention of PIC.Methods The fixed-effects or random-effects model was performed on studies on risk factors of PIC in HCC patients published from January 1990 to May 2015 by searching the PubMed,Embase,CNKI,VIP and Wanfang Data.Results Fourteen studies involving HCC 5 841 patients were included in this meta-analysis.The level of serum albumin was significantly lower in the PIC group than the NPIC group (WMD =-1.80,95％ CI:-2..79 ～-0.80 ; P ＜ 0.05) ; Patients with diabetes mellitus had a higher incidence of PIC than those without diabetes mellitus (OR =1.94,95％ CI:1.27 ～ 2.95 ; P ＜ 0.05) ; Patients with operation time less than 5 h had an decreased incidence of PIC than the other group (OR =0.31,95 ％ CI:0.22 ～ 0.45 ; P ＜ 0.05).Patients with blood loss less than 2 000 ml had a lower incidence of PIC than the other group (OR =0.30,95％ CI:0.19 ～ 0.48 ; P ＜ 0.05).Patients with blood transfusion had a higher incidence of PIC than those without transfusion (OR =2.83,95％ CI:2.04 ～ 3.93 ; P ＜ 0.05).Patients with postoperative bile leakage had a higher incidence of PIC than those without bile leakage (OR =3.79,95％ CI:2.06 ～ 6.96; P ＜ 0.05).Patients after primary hepatectomy had a higher incidence of PIC than those after repeat hepatectomy,but there was no significant difference between the two groups (OR =1.52,95％ CI:0.99 ～ 2.33 ; P =0.05).Patients with tumor diameter less than 5 cm had a higher incidence of PIC than the other group,but there was no significant difference between the two groups (OR=1.09,95％CI:0.76 ～1.56; P＞0.05).Conclusion A low level of serum albumin,diabetes mellitus,operation time more than 5 h,blood loss more than 2 000 ml,blood transfusion,bile leakage were risk factors for the development of PIC.

Objective To investigate the effect of Dicer knockdown on the proliferation,migration and invasion of cholangiocarcinoma cell line TFK-1.Methods The study used liposome-mediated method to transfect Dicer-siRNA into TFK-1 cells.The mRNA and protein expressions of Dicer after transfection were detected by real-time PCR and western blot.CCK8 assay,scratch test and transwell assays were performed to analyze the influence on the proliferation,migration and invasion of cells,respectively.Results Compared with the control,Dicer mRNA level at 48 h and Dicer protein level at 96 h were both significantly reduced after transfection with Dicer-siRNA (P ＜ 0.01).CCK8 assay revealed that the absorbance value significantly increased at 72 h,96 h and 120 h after transfection (P ＜0.01).Scratch test and transwell assay showed that the migration ability and the number of invasive cells significantly increased (P ＜ 0.05).Conclusion Dicer knockdown enhanced the proliferation,migration and invasion of cholangiocarcinoma cell line TFK-1.

Objective To observe the effect of leflunomide and cyclophosphamide combined with prednisone in the treatment of idiopathic membranous nephropathy .Methods 30 patients with idiopathic membranous nephropa-thy were randomly divided into two groups ,15 cases in each group .A group was treated by leflunomide combined with prednisone , B group was treated by cyclophosphamide combined with prednisone , 6 months a course .The clinical effect,24h urine protein quantity,serum albumin levels,blood fat,renal functions and adverse reactions were com-pared.Results 3,6 months after treatment ,the remission rates in A group were 60.00%,73.33%,those in B group were 53.33%,66.67%(χ2 =0.965,0.896,all P>0.05).After treatment,24h urine protein quantity,serum albu-min levels in the two groups [A group:(1.33 ±1.25)g/24h,(38.24 ±4.84)g/L;B group:(1.42 ±1.37)g/24h, (37.12 ±5.43)g/L] were significantly lower than those before treatment [A group:(7.34 ±2.75)g/24h,(20.31 ± 7.33)g/L;B group:(7.22 ±2.84)g/24h,(20.46 ±7.73)g/L] (A group:t=6.232,5.734,all P<0.05;B group:t=5.934,5.267,all P<0.05).After treatment,total cholesterol,triglyceride in the two groups [A group:(6.74 ± 1.45)mmol/L,(2.43 ±0.75)mmol/L;B group:(6.63 ±1.45)mmol/L,(2.14 ±0.63)mmol/L] were significantly lower than those before treatment [A group:(11.94 ±2.98) mmol/L,(3.56 ±1.35) mmol/L;B group:(11.53 ± 2.84)mmol/L,(3.24 ±1.46)mmol/L] (A group:t=6.246,5.234,all P<0.05;B group:t=5.256,5.672,all P<0.05).There were no significant differences in urea nitrogen ,serum creatinine between before and after treatment in the two groups(all P>0.05).There were no significant differences in above indicators between A group and B group after treatment (all P>0.05).The incidence rate of adverse reactions in A group (13.33%) was significantly lower than that in B group(40.00%)(χ2 =4.246,P<0.05).Conclusion The clinical efficacy of leflunomide is similar to cyclophosphamide in treating idiopathic membranous nephropathy with fewer adverse reactions .

Objective To explore the method for repair of total avulsion of 2~4 fingers and to find the best procedure. Methods The wrap-round flap with part toenail combind with the dorsal pedical flap to repair soft tissue defect of the dorsal of finger and part of the palmar of finger, the second simepulp flap to repair soft tissue defect of the palmar of finger,transfer of two tissues with one pedicle to repair total avulsion of 2~4 fingers. Results All of 9 composite transplants in 6 cases were survived,the received areas were primary healing in 8 finger,1 case repaired by the bilateral wrap-round flaps and second simepulp flaps for index and middle finger,the distal phalanx of middle finger necrosis because of dislocation of DIP,3 months later,injury healed after the necrosis of phalanx excised,but the nail and the nail bed were dead.Except 1 case which the grafted skin necrotized in the donor area of the big toe,the rest had primary healing.All cases were followed up 6~14 months,the activity of joints were: MP 0-70,PIP 0-40.The repaired pulps had excellent appearance,the nail was fine,1 finger's mail was atrophy and 1 finger's nail was defect.The donor area had good fountion without pain and edema,the grafted skin had normal color and the activity of joints were nomal. Conclusion The wrap-round flap with part toenail combined with the second simepulp flap is a good approach in treatment of the skin avulsion injury in the finger.

Objective To investigate the effect of orphan nuclear receptor NR4A1 expression on oxygenglucose deprivation (OGD)-induced apoptosis in cultured rat cerebellar granule neurons and its possible mechanisms.Methods Primary rat cerebellar granule neurons were cultured for 7 to 8 days,and then treated with OGD.The activity of cultured rat cerebellar granule neurons was assessed by methyl thiazolyl tetrazolium (MTT) assay,apoptosis was detected with flow cytometry,the expressions of NR4A1,caspase-3 and cytochrome c were determined by Western blot analysis,NR4A1 mRNA expression was detected with real-time polymerase chain reaction.The rat cerebellar granule neurons were transfected with lentiviral vector-encoding rat NR4A1.The apoptotic rates and expressions of caspase-3 and cytochrome c in rat cerebellar granule neurons transfected with NR4A1 were detected after OGD.Results The activity of rat cerebellar granule neurons decreased significantly,the apoptotic rate increased significantly,the expressions of NR4A1 mRNA and protein as well as caspase-3 and cytochrome c incrased significantly along with the OGD time.NR4A1 was overexpressed,apoptosis rate was significantly reduced in rat cerebellar granule neurons transfected with NR4A1.The expressions of caspase-3 and cytochrome c were significantly reduced in the rat cerebellar granule neurons transfected with NR4A1 after OGD.Conclusions NR4A1 overexpression may reduce OGD-induced apoptosis in rat cerebellar granule neurons by downregulating the expressions of caspase-3 and cytochrome c.

Purpose To explore the clinical value of131I-whole body scan (131I-WBS) and 18F-FDG PET/CT on the metastatic management of patients with differentiated thyroid cancer (DTC) after operation.Materials and Methods Serum thyroglobulin (Tg) of 27 patients after DTC surgery was measured one day before131I therapy, and the patients underwent131I-WBS on 3-5 days after131I therapy. According to the results of Tg and 131I-WBS, all the patients were divided into 4 types as follows: type I: Tg (+),131I-WBS (-); type II: Tg (+),131I-WBS (+); type III: Tg (-),131I-WBS (+); and type IV: Tg (-), 131I-WBS (-). Then the patients received18F-FDG PET/CT scan within a week after 131I-WBS. The results of131I-WBS and18F-FDG PET/CT scan were analyzed according to histopathologic findings or clinical and imaging follow-up of at least 6 months as diagnosis standard.Results The examinations uncovered that metastasis occurred in 52 lesions of 22 cases out of the 27 cases.131I-WBS revealed 24 metastatic lesions (46.2%) in 8 cases (36.4%), and18F-FDG PET/CT showed 35 metastatic lesions (67.3%) in 15 cases (68.2%), the difference with statistic significance (χ2=4.46 and 4.74,P<0.05). Metastasis were confirmed in 13 type I cases (100.0%); 5 type II cases (100.0%); 3 type III cases (100.0%) and 1 type IV case (16.7%), respectively. The rate of detecting metastasis by 18F-FDG PET/CT was 100.0% in type I, 20.0% in type II, 0% in type III respectively, the difference with statistic significance (χ2=9.14 and 10.11,P<0.05); and 100.0% in type IV, the difference without statistic significance (χ2=1.25,P>0.05). Based on that, therapeutic plans were modified for 13 patients with type I metastasis and 1 patient with type IV metastasis.Conclusion131I-WBS and18F-FDG PET/CT are complementary for detecting metastatic lesion and help to decide the following treatment of DTC patients after surgery. Moreover,18F-FDG PET/CT shows advantages in detecting metastatic lesion in Tg-positive and negative131I-WBS type of DTC patients after surgery, thus can provide an important clinical guidance for this type of patients.

Objective To investigate the effects of Zuogui Jiangtang Yishen decoction (ZGJTYS) on the expression of nephrin and podocin in podocyte of MKR mice with diabetic nephropathy (DN), and explore its mechanism. Methods Forty MKR mice (8 weeks old) were randomly divided into four groups as follows:negative control group (group A), DN model group (group B), ZGJTYS group (group C) and positive control group (group D, Gliquidone and benazepri). All mice from group B, C and D were received high-fat diet feed and unilateral nephrectomy. Four weeks after operation, all mice were received drug intervention, and four weeks later, all mice were put to death. The levels of UmAlb were observed by ELISA, the serum BUN and Cr by biochemical, and the FBG by electrochemical detection method. The nephrin and podocin mRNA expression were measured by RT-PCR and the protein expression by western blotting. The morphological structure changes of the podocytes were observed by transmission electron microscopes. Results As compared with group A, FBG, BUN, SCr and urine UmAlb in the mice of group B increased significantly (P<0.01), the expression level of nephrin and podocin mRNA and protein were markedly decreased (P<0.01). After intervention of drugs, all biochemical indicators above in the mice of group C and D significantly decreased (P<0.01), the expression level of nephrin and podocin mRNA and protein were markedly increased (P<0.01, P<0.05), compared with group B. The renal pathological lesions of group C and D were significantly improved compared with group B. Conclusion ZGJTYS decoction exerts reno-protective effect via reinstating nephrin and podocin expression to repair the damaged podocyte.

Objective To quantitatively analyze the correlation between stenosis ratio and cerebral perfusion in patients with solely symptomatic M1 stenosis of middle cerebral artery.Methods All the patients with solely symptomatic M1 stenosis of middle cerebral artery were selected to this study from consecutive 203 patients with elective stenting of symptomatic intracranial artery stenosis.Brain CT, CT perfusion (CTP) and DSA examinations were performed in all cases.The CTP parameters of mean transit time (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured in regions of interest (ROIs) including bilateral frontal lobe, anterior watershed, opercula of the insula (including parsopercluaris and part of insula), temporal lobe, posterior watershed and occipital lobe.Compared with the unaffected side as control, the change of CTP and their relative CTP parameters in these ROIs at affected side were analyzed.Based on DSA data, the ratio of M1 stenosis was measured manually and blindly, the source of collateral branch of compensative artery was estimated and the blood flow was graded.Correlation between the ratio of M1 stenosis and the CTP parameters including the absolute and the relative values was investigated.Results Twenty patients were selected into this study; their average M1 stenosis ration of the affected side was 70.5% ± 10.6% (53% to 91%).Compared with the unaffected side, MTT and CBF were no significant change but CBV increased in the affected frontal lobe; MTT prolonged, CBF was normal and CBV increased in the affected anterior watershed and opercula of the insula; MTT prolonged, CBF and CBV had no significant difference in the affected temporal lobe; MTT prolonged, CBF decreased and CBV had no significant difference in the affected posterior watershed; MTT, CBF and CBV were normal in occipital lobe.Tissue perfusion gradually decreased from the front to the backward in all the M1 stenosis affected cerebral regions and the posterior watershed area was the only region at hemodynamic failure stage.Leptomeningeal vessels of the anterior cerebral artery were the major sources of compensative arteries shown in the DSA in all cases.The ratio of M1 stenosis was positively correlated (r =0.66, P =0.002) with the rCBV in posterior watershed and there is no significant correlation between the ratio and any other CTP parameters in any regions.Conclusions Associated with distribution of collateral compensative artery,tissue perfusion showed obvious spatial distribution at different level in different cerebral region.M1 stenosis ratio is positively correlated with rCBV in hemodynamic failure regions, and there is no correlation with tissue perfusion in hemodynamic compromise regions.

BACKGROUND:Osteoporosis caused by chemotherapy has become one of the serious side effects that impact the skeletal system. Icarin shows a strong anti-osteoporosis activity, which can have protective effect on osteoporosis induced by chemotherapy. OBJECTIVE: To study the protective effect and mechanism of icarin against cyclophosphamide-induced obstacle of mouse bone marrow mesenchymal stem cels differentiating into osteoblasts. METHODS:MTT assay and alkaline phosphatase (ALP) staining were used to determine the optimal protective concentration of icarin against cyclophosphamide-induced obstacle of mouse bone marrow mesenchymal stem cels differentiating into osteoblasts. mRNA expressions of osteoblast-specific transcription factors, OC, ALP, Runx2, and Wnt/β-catenin signaling pathway target genes, β-catenin, C-Myc, cyclin D1, were determined using RT-PCR method at different time after intervention with the optimal concentration of icarin. Expressions of Runx2, β-catenin, c-Myc, cyclin D1 regulated by the optimal concentration of icarin were detected using western blot assay at the protein level. RESULTS AND CONCLUSION:Cel viability and ALP activity decreased significantly in the cyclophosphamide group compared with the control group, but there was no significant difference in cel viability between icarin group and cyclophosphamide group. Icarin at 100 μmol/L showed the best protective effect against cyclophosphamide-induced obstacle of osteogenic differentiation of bone marrow mesenhymal stem cels. Compared with the control group, cyclophosphamide chemotherapy reduced the expressions of ALP, OC, Runx2 at mRNA level and Runx2 at protein level, weakened the expressions ofβ-catenin, cyclin D1 at mRNA level and active β-catenin, Cyclin D1, c-myc at protein level, and increased the expression of DKK1. Compared with the cyclophosphamide group, 100 μmol/L icarin increased the expression of osteoblast-specific transcription factors and Wnt/β-catenin signaling pathway genes at mRNA and protein levels, and reduced the expression of DKK1 protein. These results show that cyclophosphamide can lead to osteogenic differentiation disorder of mouse bone marrow mesenchymal stem cels, and in contrast, icarin shows a protective effect and its optimal intervention concentration is 100 μmol/L. Additionaly, the protective roleof icarin is probably related to activation of Wnt/β-catenin signal pathway.

Objective To explore the prevalence of the nuclear dense fine speckled ( DFS ) immunofluorescence pattern in routine antinuclear antibodies(ANA) testing and its significance in patients with autoimmune diseases( AID) .Methods The ANA in 13 728 specimens were measured by indirect immunofluorescence( IIF) using HEp-2 cell slides from department of clinical laboratory, wenling hospital from 2011 to 2014.The frequencies, clinical manifestations and laboratory features of DFS positivity were restrospectively analyzed in patients with AID,usingχ2 test.Results ANA was positive in 20.56%(2 822/13 728) of the total patients, and the frequency of DFS pattern was observed in 1.81%(248/13 728) of the total patients and in 8.79%(248/2 822) of the patients with ANA positivity.In different age groups (≤20 years old, 21-49 years old and≥50 years old) , there were statistical significance of DFS pattern positive rate (male:χ2 =18.17,P<0.01; female: χ2 =1 500.00,P<0.01).And the highest frequency of ANA positivity was observed in patients from department of rheumatology(30.07%).The frequency of DFS pattern was higher in the departments of infection ( 32.58%) , dermatology ( 21.76%) , neurology ( 18.58%) and nephrology(6.73%) among the patients with ANA positivity(χ2 =123.00,P<0.01).Amony the 248 cases with DFS pattern positivity.41 cases were AID ( 16.53%) and 207 cases were non-autoimmune diseases ( 83.47%) . In AID group 13 cases were autoimmune thyroiditis ( 31.71%) , 12 cases were rheumatoid arthritis ( 29.27%) , 4 cases were autoimmune liver disease ( 9.76%) , 4 cases were undifferentiated connective tissue disease (9.76%), 3 cases were ankylosing spondylitis(7.32%), 2 cases were Sj?gren′s disease ( 4.88%) , 2 cases were inflammatory bowel disease ( 4.88%) and 1 case was systemic lupus erythematosus(2.44%).The titers of DFS in patients with AID were predominantly above 1∶320 and less than 1∶100 in non-AID.AID patients with DFS pattern positivity have different clinical manifestations and laboratory features.Howerer, antinuclear antibodies ( ANAs ) in 15 specific auto-antibodies were all negative.Conclusions The DFS pattern is a common pattern in ANA positivity patients and it mainly exists in non-AID patients.Further more, it is suggested that patients with DFS pattern identified by IIF should then be tested for anti-DFS70 antibodies with a specific immunoassay.