Objective To introduce the clinical significance and pathophysiologic aspects of the circulatory and cardiac complications in terminal stage cirrhosis.Methods Recently relevant literatures were reviewed and summarized.Results Haemodynamic changes in cirrhosis arose on the basis of combined humoral and nervous dysregulation,with abnormalities in cardiovascular regulation,volume distribution and cardiac performance.Conclusion Comprehending the mechanisms of cardiovascular complications will contribute a lot for the treatment of terminal stage cirrhosis.

In the course of hospital regrouping it is imperative to integrate medical functions, resource elements and hospital cultures. Yet the integration of hospital cultures plays a pivotal role, for the culture of a hospital is the basis of its survival and development and cultural integration can lead to the fusion of the staffs feelings, values and concepts and to the coordinated development of the hospitals hardware and software, which will produce greater benefits. Ways of cultural integration include: ①doing a good job of intention surveys and ideological persuasion prior to hospital regrouping; ②adopting different forms of cultural fusion for different forms of regrouping: with unbalanced regrouping, the cultures of the weaker hospitals should not be totally negated and attention should be paid to equality and impartiality, whereas with balanced regrouping, efforts should be made to enhance communications rather than to differentiate the primary and the secondary; ③giving full play to the role of informal organizations within the hospital in the fusion of different cultures.

Objective To find out universal problems in restructuring and explore relevant methodologies so as to provide the government with decision-making basis. Methods The method of partial quantification from statistics and operational research and the qualitative method from sociology were employed. Results Hospitals A and B assumed the functions of a second-tier hospital and satisfied the basic medical needs of District Z. With Hospital A being superior to Hospital B and inpatient service superior to outpatient service, the obstruction to the restructuring lay in the staffs of the two hospitals. If the restructuring should turn out to be successful, there would be more space for the expansion of their share of the medical market. The focus of the restructuring should be put on the advancement of technologies and the improvement of quality and efficiency. In particular, the basic medical needs of the residents in the areas concerned must be met. Conclusion In restructuring two hospitals, the model of loose cooperation and steady combination is recommended in the first place while the government ought to play the role of providing guidance, coordination and policy support.

Sorafenib is a molecular targeted drug for the treatment of advanced primary liver cancer.However,along with the occurrence of drug resistance,the therapeutic effect was effected.At present,there is clear evidence that the emergence of drug resistance of live cancer is closely related to the epithelial-mesenchymal transition,liver cancer stem cells and the heterogeneity of liver cancer,and the PI3K/AKt signaling pathway as the vital common signaling channel was involved in the above mentioned process.From this we can conclude that complementary inhibtion of PI3K/AKt signaling pathway at the same time is the method that can strengthen the effect of sorafenib on the treatment of liver cancer so far.

Objective Analyse the causes,diagnosis and treatment for delayed hemorrhage after distal radical gastrectomy.Methods Retrospective study on 45 patients combined with intro-abdominal hemorrhage after distal radical gastrectomy from January 2008 to June 2013.Results Thirteen patients combined with delayed hemorrhage in these 45 patients,all of 13 patients had intro-abdominal hemorrhage in 1week to 4 weeks after operation.And 5 of the 13 patiens were intermittent intro-abdominal hemorrhage 1 week after operation,these patients were demonstrated the blood come from gastroduodenal artery pseudoaneurysm fracture by CT and DSA examine,and they were cured by interventional embolization.Other 8 patients were marginal ulcer hemorrhage diagnosed by gastroscope,and they stoped bleeding with the help of gastroscope.Conclusions The causes of delayed hemorrhage after distal radical gastrectomy were complicated,and CT,DSA and endoscope can use for diagnosis.What was more,interventional embolization and endoscope were helpful for curing the intro-abdominal hemorrhage,avoiding re-operation.

Objective: To establish a risk prediction model and scoring system in patients with side branch (SB) occlusion during coronary bifurcation intervention. Methods: A total of 7007 consecutive patients who received percutanenous coronary intervention (PCI) in our hospital from 2012-02 to 2012-07 were recruited and 1545 patients (with 1601 bifurcation lesions) treated by single stent technique or main vessel stenting ifrst strategy were selected for our study. According to weather SB occlusion occurred during operation, the lesions were divided into 2 groups: Non-SB occlusion group,n=1431 and SB occlusion group,n=114. The data set of the ifrst 1200/1601 lesions by time sequence, was used for establishing the risk model and scoring system, the data set of rest 401 lesions was used for model validation. Results: The modeling data set presented that the relationship between pre-operative main vessel plaque and the position of branch vessel, the main blood vessel pre-stenting TIMI grade, the stenosis degree of pre-operative bifurcation nucleus, the angle of pre-operative bifurcation and the ratio of pre-senting stenosis degree of branch diameter and pre-operative main vessel to branch vessel diameter were the independent risk factors for branch occlusion. The risk model ROC=0.80, 95% CI 0.75-0.85, Hosmer-Lemeshow HLP=1.00; the scoring system ROC=0.76, 95% CI 0.71-0.82, HLP=0.12. The validation data set ROC=0.81, 95% CI 0.73-0.89, HLP=0.77; the scoring system ROC=0.77, 95% CI 0.69-0.86, HLP=0.58. The quartile integration of both data sets indicated that the patients with the integration score ≥ 10 had the higher risk for SB occlusion than those with integration score < 10 during the operation,P<0.001. Conclusion: Our research developed a simple and user-friendly system, it may distinguish the patients with high risk of SB occlusion during bifurcation intervention by quantitative stratiifcation of coronary angiographic imaging.

Objective To decrease radiation induced toxicities especially mucostis in patients with locally advanced nasopharyngeal carcinoma( NPC ) who underwent concurrent radiochemotherapy, the maximum tolerated dose and dose limited toxicities of capecitabine combination with cisplatin were observed. Methods From Aug 2006 to Oct 2007, 24 patients with intensity modulated radiotherapy(IMRT) and concurrent chemotherapy with capecitabine and cisplatin for nasopharyngeal carcinoma(stages Ⅲ-Ⅳ) were enrolled in this study. There were four dose-level groups of Capecitabine[625-1250 mg/(m2 ·d) , d1-14]and fixed cisplatin dose[20 mg/(m ·d) ,d1-5) ]MRI and CT scan were used for evaluation of tumor shrinkage. Treatment related toxicities were evaluated according to the common toxicity criteria( NCI-CTC Version 3.0). Results The acute side-effects include Grade 3 or Grade 4 mucosal toxicity(lasting for at least 5 d) and Grade 3 or Grade 4 non-mucosal toxicity were evaluated. Group 625 mg/m2 and Group 825 mg/m2 had none, Group 1000 mg/m2 had 6 patients and Group 1250 mg/m2 had 3 patients for mucosal toxicity, which were the main dose-limited toxicity and relevant to the dose of capecitabine apparently( P < 0. 05 ). There was also a trend of increase by the dose level of capecitabine for other toxicities. The median follow-up time for all patients was 28. 5 months. The locoregional recurrence occurred in 2 patients and distant metastasis in 2 patients. Two-year overall survival rate and locoregional control rate were 100% and 91.7%, respectively.Complete response and partialresponse were found on MRI or CT scan in patients of 29. 2% at the end of treatment and 83. 3% after three months, respectively. Conclusions The combination regimen of capecitabine and cisplatin is safe and effective according to the preliminary result. Toxicities related to radiochemotherapy for NPC were significantly associated with the dose level of chemotherapy.

Diagnosis, Differential ; Diarrhea ; etiology ; Humans ; Infant ; Male ; Mediastinal Cyst ; complications ; diagnosis ; surgery ; Mediastinal Neoplasms ; complications ; diagnosis ; Respiratory Sounds ; etiology ; physiopathology ; Treatment Outcome ; X-Rays

0.05). CONCLUSIONS Levofloxacin is suited to prevent and treat the infection during the perioperation of appendectomy due to acute appendicitis.

Objective:To explore the relationship between YKL-40 and the proliferation of breast cancer and its mechanism.Methods:The expression of YKL-40 in breast cancer MCF-7 cells was detected by immunofluorescence assay.Fluorescence microscope was used to observe the conversion efficiency,and Real-time PCR was used to screen the most effective YKL-40 siRNA.Expression levels of PI3K,P-PI3K,AKT,P-AKT of the PI3K/AKT pathway associated proteins was test by Western blot.At the same time,MTT and flow cytometry were validated by YKL-40 siRNA treatment of human breast cancer MCF-7 ceils,the differences of 24h,48h and 72h groups of cell proliferation ability and cell cycle.Result:MCF-7 cell express YKL-40 protein,mainly located in the cytoplasm.Real-time PCR show that siRNA01,siRNA02,siRNA03 compared with NC group YKL-40 gene silencing effect is remarkable.Among of them the strongest silencing effect is siRNA02 (P＜0.01),Western blot show the experimental group than the control group,Total PI3K and AKT remain unchanged while P-PI3K,P-AKT expression decreased (P＜0.05).In the experimental group,the number of G1 cells in the control group was increased (P＜0.01),while the S phase cells decreased (P＜0.01).MTT results showed that the experimental group compared with the control group,the proliferation ability is decreased(P＜0.01).Conclusions This study suggests that YKL-40 can be used as the upstream regulatory factor of PI3K/AKT signaling pathway and affect the process of cell cycle in breast cancer,and then regulate the proliferation of breast cancer,YKL-40 may be a crucial target for the treatment of breast cancer.