Objective: To validate the clinical value of CT-guided curve-needle percutaneous ethanol injection (CNPEI) for celiac plexus block analgesia. Methods: Thirty-two patients with end-stage cancer, including 13 complicated with extensive retroperitoneal lymph node enlargement and fusion, were enrolled in this study. All patients complained of refractory upper abdominal pain and had received narcotic analgesics and radiotherapy, but the analgesic effect was not good. CT-guided CNPEI was therefore prescribed. Results: The effective rates of CT-guided CNPEI were 100%, 100%, 96.9%, 90.6%, 87.5%, and 84.4% immediately, and at 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after treatment, respectively. All enlarged lymph nodes had obvious necrosis and became shrunk. Conclusion: Combined application of bilateral anterior and posterior diaphragmatic crura block and trans-lymph node block can produce good analgesic effects, and curve-needle puncture make the above technique simpler.

Objective To determine the expression of Notch pathway receptors (Notch1 and Notch4) and ligands (Jagged1 and Dll4) in cutaneous malignant melanoma (CMM) tissues,and to preliminarily explore the role of the Notch signaling pathway in the pathogenesis of CMM.Methods Immunohistochemical study was performed to determine the expression pattern and intensity of Notch1,Notch4,Jagged1 and Dll4 in 40 paraffin-embedded CMM specimens and 15 paraffin-embedded pigmented nevus specimens.Statistical analysis was carried out by chi-square test and Spearman rank correlation analysis with the SPSS 21.0 software.Results Notchl was detected in 31 (77.5％) of 40 CMM specimens,as well as in 3 of 15 pigmented nevus specimens,and the positive rates significantly differed between the two groups (x2 =15.281,P ＜ 0.001).However,no significant difference in the expression intensity of Notch1 was observed between 18 in situ melanoma tissues and 22 invasive melanoma tissues (x2 =0.631,P =0.427).In addition,the positive rates of Notch4,Jagged1 and Dll4 were also significantly higher in the CMM group than those in the pigmented nevus group (all P ＜ 0.05),and the expression intensity of Notch4,Jagged1 and Dll4 significantly differed between in situ and invasive melanoma tissues (all P ＜ 0.05).In CMM tissues,the expression of Notch1 was positively correlated with that of Jagged1 (rs =0.350,P =0.027) and Dll4 (rs =0.562,P ＜ 0.001),while the expression of Jaggedl was negatively correlated with that of Dl14 (rs =-0.734,P ＜ 0.001).Conclusion Abnormality of the Notch signaling pathway may be involved in the pathogenesis of melanoma,but further researches are still needed to elucidate the detailed mechanism.

Objective:To study the influence of thrombus aspiration combined tirofiban on patients with acute ST seg-ment elevation myocardial infarction (STEMI)after primary percutaneous coronary intervention (PCI).Methods:A total of 98 patients,who received primary PCI because of STEMI in our hospital from Jan 2012 to Mar 2013,were selected.They were divided into thrombus aspiration group (n=48,received pure thrombus aspiration)and com-bined treatment group (n = 50,received thrombus aspiration combined intracoronary tirofiban injection during PCI).Coronary angiography (CAG)instantly after PCI and follow-up condition during hospitalization and six months after discharge were compared between two groups.Results:(1)Compared with thrombus aspiration group after PCI,there were significant rise in TIMI blood flow grade [(2.3±0.6)grades vs.(2.7±0.3)grades],per-centage of TIMI flow grade 3 (72.9% vs.90.0%)and ST segment regression >50% rate within 90min after PCI (52.1% vs.74.0%),P < 0.05 or < 0.01,and significant reduction in percentage of postoperative no-reflow (18.8% vs.4.0%,P =0.038)in combined treatment group in hospital;(2)After six-month follow-up,left ven-tricular ejection fraction (LVEF)of combined treatment group was significantly higher than that of thrombus aspi-ration group [(58±6.3)% vs.(51±5.6)%,P <0.05].Conclusion:Thrombus aspiration combined tirofiban can effectively reduce coronary thrombus burden and improve cardiac function in STEMI patients during primary PCI.

Human papilloma virus (HPV) infection is closely correlated with the occurrence of cervical cancer and precancerous lesion, high risk HPV can induce cervical cancer by the corresponding protein of E6 and E7 gene expression. Earlier diagnosis and earlier prevention of HPV infection are the key points in blocking cervical cancer, and combined use of Chinese herbal preparations with Western medicine is the important way for preventing HPV infection and prohibiting cervical canceration. So, to develop anti-viral chemical compound from natural drugs has become the hotspot of research today.
Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Interferons ; therapeutic use ; Oncogene Proteins, Viral ; analysis ; Papillomavirus E7 Proteins ; analysis ; Papillomavirus Infections ; drug therapy ; Phytotherapy ; Repressor Proteins ; analysis ; Uterine Cervical Neoplasms ; drug therapy ; virology

Objective To study the optimal enhancement phase and exact triggering scan time on spiral CT angiography of vertebral and carotid artery,and to improve the rate of 3D-CT display in vertebral and carotid artery.Methods One hundred and thirty-three cases of CT angiography of vertebral and carotid artery(87 vertebral and 46 carotid artery)were examined with SmartPrep software,which controled the scan at real time after 100 ml contrast medium(350 mg I/ml Omnipaque)were quickly injected through foot back vein.One hundred and thirteen cases of control group were examined by triggeing off the scanning with a delay time of 18—22 s after blous injection through foot back vein.The vertebral and carotid arteries were demonstrated with 3 dimensional reconstruction.Results The successful rate in SmartPrep group was 100% with the enhancement situated in best(n=130)or good(n=3)scanning phase.The threshold concentration values of target vessel were kept on 100 HU in the whole scan period[(18?4)s].However, the triggering time of enhancement scanning was not equal(15—43s)and the deviation was up to 28 s.The average concentration of target vessel was obviously higher in SmartPrep group[(161.4?2.0)HU]than in the control group[(133.3?2.2)HU](t=-9.456,P

Animals ; Epithelial-Mesenchymal Transition ; Fibrosis ; Kidney ; pathology ; Kidney Tubules ; cytology ; Male ; Rats ; Rats, Sprague-Dawley ; Ureteral Obstruction ; pathology

For screening the potential drugs as anti-liver fibrosis candidates, we established a high- throughput drug screening cell model based on COL1A1 promoter. The activity of COL1A1 promoter and luciferase reporter gene can be elevated by TGF-β1, and inhibited by candidate drugs. We constructed a recombined plasmid with COL1A1 promoter and luciferase reporter gene pGL4.17, the activity of COL1A1 promoter was reflected by fluorescence intensity. COL1A1 promoter activity was detected by Dual-Luciferase Reporter Assay System, it came that the relative luciferase activity of COL1A1 promoter was 15.98 times higher than that of control group induced by TGF-β1, showing the recombined plasmid could be used in cell model. The recombined plasmid was transfected into human hepatic stellate cells LX2, detected the effect of potential drugs, and obtained a stable expression system through stable transfection and monoclonal cell culture. A sample which could reduce COL1A1 promoter activity signally by our cell model, decreased collagen I mRNA and protein expression detected by real-time RT-PCR and Western blotting. It indicates this novel cell model can be used in high-throughput drug screening of potential anti-liver fibrosis drugs.
Collagen Type I ; genetics ; Drug Evaluation, Preclinical ; methods ; Genes, Reporter ; Hepatic Stellate Cells ; High-Throughput Screening Assays ; Humans ; Liver Cirrhosis ; drug therapy ; Luciferases ; Plasmids ; Promoter Regions, Genetic ; RNA, Messenger ; Transfection ; Transforming Growth Factor beta1 ; pharmacology

BACKGROUNDTaiwan has implemented a National Health Insurance (NHI) program to provide uniform comprehensive coverage since 1995. Forced by the severe financial deficit, global budgeting is introduced to replace the original payment system in Taiwan's NHI. Under global budgeting system, the total budget is distributed to six geographical regions in Taiwan. There is no pre-determined budget for each hospital. In order to investigate the longitudinal trend of how global budgeting influences health care resource, it is essential to estimate the efficiency of resource allocation in Taiwan's NHI.

METHODSData Envelopment Analysis (DEA) and Malmquist index (MI) are used to investigate the 8-year panel data of 23 cities and counties which was collected from the annual report from the Department of Health, Taiwan, China. A value of MI greater than 1 indicates that total factor productivity progress has occurred, while a value of MI less than 1 indicates productivity loss.

RESULTSAs a result, 37 of the 184 DMUs in the analysis were found to be relatively efficient during the period, in which 14 of 23 DMUs are efficient in 2002 right after adopting globe budgeting. A trend of MI declines between 2002 and 2009 implies the volume of health care services decrease after adopting global budgeting system. Production efficiency has been improved after global budgeting implies that behaviors of health providers control cost and avoid wasting resource at macro level.

CONCLUSIONSThe regressive MI indicates the hospitals redistribute health care resource to eliminate unnecessary treatment and to control the growth of service volume under global budgeting system. Hence, a trend of declining MI focuses on health care resource redistribution rather than efficiency improvement in this study.

Budgets ; Hospital Administration ; economics ; National Health Programs ; economics ; Resource Allocation ; methods ; Taiwan

OBJECTIVETo explore clinical results of open reduction and internal fixation (ORIF) for posterior Pilon fracture through posterolateral approach.

METHODSSeventeen patients with posterior Pilon fracture were treated through posterolateral approach from February 2010 to April 2013. Among them,including 11 males and 6 females aged from 29 to 59 with an average of 43.4 years old. All fractures were associated with more than 20% of articular surface of distal tibial. The causes of injury included falling down (11 cases), traffic accident (4 cases) and sports injury(6 cases). Fracture classification was based on posterior pilon fracture by YU Guang-rong, including type I (6 cases), type II (2 cases) and type III (6 cases). Fracture healing time, fracture reduction and postoperative complications were observed, AOFAS score were applied to evaluate clinical efficacy.

RESULTSAll patients were followed up from 13 to 24 months with an average of 20.5 months. All incisions were healed at stage I, and fractures obtained healing,the time of fracture healing ranged from 12 to 21 weeks with an average of 15.2 weeks. No incision infection, neurovascular injury, bone ununion and fracture deformity were found after operation. Postoperative AOFAS score was 92.0 ± 10.2, and 14 cases got excellent results, 2 good and 1 moderate.

CONCLUSIONPosterior pilon fracture through posterolateral approach could obtain effective reduction, stable fixation. It is a safe, simple and effective operation for treating posterior Pilon fracture, and it is worth popularizing.

Adult ; Ankle Fractures ; surgery ; Ankle Joint ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery