Objective To compare the therapeutic effect of endoscopic variceal ligation (EVL) and β-blockers plus isosorbide mononitrate (ISMN) in prevention of esophageal varieeal re-bleeding. Methods The randomized clinical trials (RCTs) on EVL and β-blockers plus ISMN for the prevention of esophageal varieeal re-bleeding were searched, and only the results from those with Jadad score higher than 3 were eval-uated with RevMan 4. 2 software for odds ratio (OR) with 95% confidence intervals (95%C1). Analysis of sensitivity was performed on the quality of the data and publication bias was investigated with funnel plots. Results Four trials matched the criteria were recruited including 504 cases with a follow-up from 8 to 25 months. There was no significant difference in rates of re-bleeding (OR =0. 93, 95% CI =0. 41 ～ 2. 11 ; P = 0. 87), re-bleeding due to esophageal varices (OR = 0. 68, 95% CI = 0. 19 ～ 2. 37 ; P = 0. 54), therapy-re-lated adverse effects (OR = 1.12, 95% CI =0. 75 ～ 1.67, P = 0. 57), severe adverse events (OR = 0. 89, 95% CI =0. 47 ～ 1.67, P = 0. 71), bleeding-related mortality (OR = 2. 11, 95% CI = 0. 88 ～ 5.08, P = 0. 10), or overall mortality (OR = 1.46, 95% CI = 0. 95 ～ 2. 24, P = 0. 09) between EVL and β-blockers plus ISMN groups. However, a trend towards lower bleeding-related mortality and overall mortality favored drug therapy. There was no heterogeneity found in the outcomes apart from re-bleeding (P = 0. 003) or re-bleeding from esophageal varices (P <0. 0001). The result of sensitivity analysis remained statistically sta-ble. Symmetric funnel plots showed there was no evidence of publication bias. Conclusion EVL and β-blockers plus ISMN show an equivalent efficacy and safety for the prevention of esophageal variceal re-bleed-ing. There is a trend towards lower bleeding-related mortality and overall mortality in drug therapy. But EVL is free from drug-related side effects, and its adverse events are similar to those of drug therapy. Thus, either of the two approaches can be used as the first choice for prophylaxis of re-bleeding of esophageal varices.

Objective To study the effects of passive movement (PM) and electric stimulation(ES) on soleus of the tail suspended rats. Methods Seventy-two male Wistar rats(68～76g) were used in this experiment and divided into a normal control group, a model group (tail suspension), a ES group (tail suspension plus ES) and a PM group(tail suspension plus PM).The cross-sectional area of the muscle fibers and proportion of various types of muscle fibers in soleus were observed by histociemical staining of succinic dehydrogenase (SDH) and image pattern analyzer. Results The results showed that the cross-sectional area of all types of soleus muscle fibers in the PM and ES groups was significantly larger than that in the model group, with the area of the intermediate muscle fibers more significantly larger in particular. The proportion of the red fibers decreased and that of the intermediate fibers increased in the model group after one week of tail-suspension. Conclusion Passive movement and electrical stimulation could slow down the muscle atrophy of soleus of the tail-suspended rats.

Objective To construct and identify the recombinant BCG (bacille Calmette-Guerin) expressing exogenous antigen, namely Dermatophagoides pteronyssinus (house dust mite), major allergen (Der p2) in form of secreting protein. Methods The gene fragments containing ?-ss signal peptide gene were amplified by polymerase chain reaction (PCR) from the Mycobacteria tuberculosis H37Rv and cloned into the Der p2-rBCG, which can express Der p2 in intracellular pattern.Then the Der p2 gene was expressed by the rBCG in form of secreting protein, and it was identified by Western blotting. Results The sequence of signal peptide gene ?-ss was verified by sequencing identification. The constructed Der p2-rBCG could shuttle from E. coli to Mycobacteria to mediat the expression of antibiotic resistance gene and it served as a vector to express the Der p2 gene as a secreted protein. Conclusions The Der p2-rBCG, which can express exogenous antigen gene in form of secreting protein, has been constructed successfully.

Objective To evaluate the arrival peak time (APT) of contrast medium to abdominal aorta at different dosages with 64-detector CT scanner.Methods Sixty cases with normal cardiac function were divided randomly into three groups(group A,B,C).The injection rate of group A,B,C was 4.5 ml/s,3.5 ml/s,4.5 ml/s respectively.A small test bolus and the enhancement dosage bolus were at the same injection rate.After the injection of contrast medium was done,20 ml saline chaser was followed in group A and B but group C.20 patients with cardiac dysfunction as group D received the same injection protocol as group A.The concentration of contrast medium was 370 mgI/ml and cine-modal was used in contrast-enhanced scanning.The time-density curve of abdominal aorta at the level of porta hepatic and APT were measured at the different group and the different dosage.Results APT of contrast medium of the small test bolus in group A,B,and C ranged from 19 s to 24 s with mean time(20?2) s,(19?3) s and(22?3) s respectively.In group D,APT ranged from 24 s to 42 s with mean time(28?14) s.APT of enhancement dosage ranged from 20 s to 26 s among group A, B,C with mean(22?3) s,(21?2) s and(24?2) s respectively.In group D,APT ranged from 26 s to 44 s,with mean time(32?14) s.The difference of APT between test bolus and enhancement dosage was 2~7 s among group A,B and C,and was 3~12 s in group D.Conclusion The APT of abdominal aorta at the level of porta hepatis between test bolus and enhancement dosage in the patients with normal cardiac function or with cardiac dysfunction is different.

Objective To investigate the characteristics of attention in children with comorbid attention deficit hyperactivity disorder (ADHD) and tic disorder (TD) (CAT). Methods 60 children with comorbid ADHD and TD (CAT), 79 children with ADHD, 60 children with TD and 71 normal control children (NG) were collected. All of those cases were evaluated with the integrated visual and auditory continuous performance test (IVA-CPT). Results It was slightly higher for visual response control quotient (VRCQ) in CAT group(85.15 ±21.10) than those in ADHD group(78.52 ± 21.85) (P ＜ 0.05), there was no significant different in the other five scores between CAT group and ADHD group (P＞0.05). It was significantly lower for the full response control quotient (FRCQ), auditory response control quotient (ARCQ) ,visual response control quotient (VRCQ), full attention quotient (FAQ), auditory attention quotient (AAQ) and visual attention Quotient (VAQ) in CAT group (83.43 ± 20.98,86.12 ± 19.88,85.15 ± 21. 10,64.88 ± 16.88,67.92 ± 17. 11 ,67.97 ± 20.04) than those in TD group(96.47 ± 17.83,97.50 ± 17.62,95.72 ± 18.87,85.37 ± 18.54,86.47 ± 17.32,87.43 ± 19.89) and those in normal control group(98.42 ± 12.67,101.50 ± 15.39,95.92 ± 11.79,99.33 ± 12.98,98.50 ± 12.09,100.00 ± 16.12) (P＜0.01). Conclusion There have serious reduced control ability and attention deficit in children with CAT. The attention deficit is attributed to the existence of ADHD.

Objective To evaluate the clinical efficacy of ultrasonic-harmonic scalpel in open thyroid surgery.Methods Totally 70 patients with thyroid surgery from January 2012 to January 2014 in some hospital were selected as the study objects, who were divided into a control group and an observation group equally. The patients in the control group went through traditional surgery, and the ones in the observation group underwent open thyroid surgery. Then the operative time, blood loss, postoperative hospital stay before and after surgery and body stress-related serum markers of two groups were analyzed and compared.Results The observation group had the operative time, blood loss and postoperative hospital stay significantly better than those of the control group, and the body stress-related serum markers 5 days after operation significantly lower than that of the control group, with P<0.05.Conclusion The short-term clinical effect of ultrasonic-harmonic scalpel in open thyroid surgery is significantly better than that of traditional surgery, which has high safety and lower degree of adverse physical stress.

Objective:To investigate the correlation between blood pressure changes within 24 h after intravenous thrombolysis and the outcome in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke treated with alteplase intravenous thrombolysis in the Department of Neurology, Anhui No. 2 Provincial People's Hospital from June 2018 to September 2020 were enrolled retrospectively. The patients who received antihypertensive therapy before and within 24 h after intravenous thrombolysis were excluded. The blood pressure before intravenous thrombolysis and the blood pressure drop within 24 h after intravenous thrombolysis were recorded. The modified Rankin Scale was used to evaluate the clinical outcome at 90 d after the onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to investigate the independent correlation between blood pressure changes within 24 h after intravenous thrombolysis and the clinical outcomes. Results:A total of 205 patients with acute ischemic stroke were enrolled, including 125 males (60.98%), 80 females (39.02%); aged 63.30±9.63 years; 124 (60.49%) had a good outcome, and 81 (39.51%) had a poor outcome. Univariate analysis showed that the proportion of diabetic patients as well as baseline systolic blood pressure, prethrombolytic blood glucose, baseline National Institutes of Health Stroke Scale score, and the incidence of symptomatic intracranial hemorrhage in the good outcome group were significantly lower than those in the poor outcome group, and the proportion of patients with small vessel occlusion and the decrease in systolic blood pressure within 24 h after thrombolytic therapy were significantly higher than those in the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that higher baseline systolic blood pressure was independently associated with the poor outcome at 90 d after intravenous thrombolysis (odds ratio 0.964, 95% confidence interval 0.942-0.987; P=0.002), and a greater decrease in systolic blood pressure within 24 h after intravenous thrombolysis was independently associated with a good outcome (odds ratio 1.134, 95% confidence interval 1.067-1.206; P<0.001). Conclusion:For patients with acute ischemic stroke who received intravenous thrombolysis, higher baseline blood pressure before intravenous thrombolysis was associated with the poor outcome, and greater decrease in systolic blood pressure within 24 h after intravenous thrombolysis was associated with the good outcome.

Objective To describe the interpositional omentum and demonstrate its clinical significance.MethodsCT and clinical data of the cases whose suprahepatic gaps widen were reviewed and the contrast of CT was adjusted to observe further.ResultsIn 1 916 cases with upper abdominal CT data,suprahepatic gap was widen in all 152 cases,and 119 cases showed fat density(6.21％ ).There were 3 cases of trauma and 3 cases of acute abdomen in the 119 cases CT in the 119 cases displayed free gas under diaphragma,but displayed fat density after contrast adjusted.There were 11 cases undergoing operations,1 for sigmoid rupture 4 liver cirrhosis and portal hypertension,3 gastric cancer,and 1 acute cholecystitis,1 bile duct carcinoma and Ⅰ case congenital cystic dilatation of common bile duct.The other 108 cases did not undergo surgical operation.ConclusionsInterpositional omentum is a clinical phenomenon that the omentum was shift in suprahepatic gap covering the liver surface.It is not rarely,the incidence rate being 6.21％ ( 119/1 916) in our study.The occurrence mechanism may be similar to that of Chilaiditi syndrome.It is difficult to differentiate interpositional omentum from free gas under diaphragms on CT plain scan picture,but it is easy after contrast adjusted of CT.Free gas under diaphragma should not be identify incorrecdied and patients should not undergo unnecessary surgical procedure.

OBJECTIVETo clone and construct a eukaryotic expression vector of human bone morphogenetic protein (BMP) 2 and histidine in vitro and synthesize chitosan (CS)/pIRES2-EGFP-hBMP2-His nanoparticles.

METHODSpMD18T-hBMP2-His was digested by EcoR I and BamH I to obtain the hBMP2-His gene, which was inserted into pIRES2-EGFP to form pIRES2-EGFP-hBMP2-His. Afterward, CS, which exhibited five different molecular weights and deacetylation degrees, was complexed with pIRES2-EGFP-hBMP2-His to form CS/pIRES2-EGFP-hBMP2-His nanoparticles; in this procedure, a desolvent method was used at different N/P ratios (amino in CS to phospho in plasmid DNA). The gene-encapsulating ability of CS was evaluated by agarose gel electrophoresis and fluorescence spectrophotometry; size, distribution, and potential were analyzed using a ZetaPALS analyzer. The shape of the nanoparticles was observed under an atomic force microscope.

RESULTS1) pIRES2-EGFP-hBMP2-His was constructed after the cloned hBMP2-His gene was confirmed by sequencing. 2) CS/pIRES2-EGFP-hBMP2-His nanoparticles were synthesized and pIRES2-EGFP-hBMP2-His was packaged by CS. 3) CS/pIRES2-EGFP-hBMP2-His nanoparticles were globular with an average size of 111.7 nm to 3,214.2 nm and an average zeta-potential of 4.93 mV to 16.79 mV.

CONCLUSIONCS/pIRES2-EGFP-hBMP2-His nanospheres are successfully synthesized.

Objective To observed the expression of serum TNF-α and IL-10 in rats with severe acute pancreatitis (SAP) at different altitudes,and to explore the relationships between TNF-α and IL-10,the pathological changes of the pancreas,and the experimental basis for clinical diagnosis and treatment of SAP.Methods 72 specific pathogen free (SPF) Wistar male rats were divided randomly into three groups:1 500 meters altitude (group L),3 300 meters altitude (group M),and 4 300 meters altitude (group H).These three groups were then each divided randomly into four subgroups:control (group n),6 hours after pancreatitis (group p 6 h),12 hours after pancreatitis (group p 12 h),and 24 hours after pancreatitis (group p 24 h).Pancreatitis was induced by intraductal administration of 5％ sodium taurocholate hydrate (NaTc).The rats were killed at 6,12,and 24 hours after NaTc injection in groups p.The group n rats were killed after 6 hours of pancreas observation.Blood samples and pancreatic tissues were collected post mortem and enzyme-linked immunosorbent assay (ELISA) measured serum TNF-α and IL-10.Results Compared with the control (group n),histopathological scores,IL-10,and TNF-α in the same altitude had a significant difference (P ＜ 0.05) in group p at each time point.In the same altitude of group p,histopathological scores and IL-10 were increased with time elapsed (P ＜ 0.05),while TNF-α was decreased with time elapsed (P ＜ 0.05).There was a significant difference between group Mp and Lp in histopathological scores,IL-10,and TNF-α (P ＜ 0.05),and the same result between group Hp and Lp (P ＜ 0.05),but there was no significant difference between group Hp and Mp (P ＜ 0.05).Meanwhile,IL-10 had a positive relationship with histopathological score,but TNF-α had a negative relationship with histopathological score.Conclusions The level of TNF-α increased with increasing altitude but significantly reduced with elapsed time.The level of IL-10 increased with both increasing altitude elapsed time.These results suggested that TNF-o and IL-10 might play a important role at different times in severe acute pancreatitis.