Objective To explore the value of FIB-4 and APRI index on evaluating the severity of liver fibrosis among patients with chronic hepatitis B(CHB).Methods A total of 218 CHB were enrolled in the study.Based on the staging of liver fibrosis,the patients were divided into 2 groups as S0-S2 group(n=120) and S3-S4 group(n=98).Differences in clinical data,laboratory indexes,FIB-4 and APRI index were compared between two groups.The correlation between FIB-4 index,APRI index and liver fibrosis were analyzed by Spearman correlation test.Receiver operator curve(ROC) test was used to determine the evaluating value of FIB-4 index and APRI index for the severity of liver fibrosis.Results To evaluate the staging≥S2 of liver fibrosis,the value of FIB-4 index was better than APRI index(Z=1.998,P=0.046).And to evaluate the staging≥S3 and S4 of liver fibrosis,the value of FIB-4 index for evaluating the staging≥S3(Z=1.177,P=0.239) or S4(Z=0.267,P=0.789) was the same as APRI index.Conclusion FIB-4 index and APRI index are both effective on evaluating the severity of liver fibrosis among patients with CHB,but the value of FIB-4 index is better than APRI index for evaluating early liver fibrosis.

Object To carry out a systematic study on the chemical constituents of Carthamus tinctorius L. In order to reveal pharmacological active compounds for their further development. Methods Three constituents were separated by macroporous resin, silica gel, polyamide, Sephadex LH-20 and spectral analysis. Results The structures were elucidated by spectroscopic means including 1D, 2D NMR and ESI-MS; they are 1-ribityl-2, 3-diketo-1, 2, 3, 4-tetrahydro-6, 7-dimethyl-quinoxaline (Ⅰ), riboflavin (Ⅱ), and uracil-ribofuranose (Ⅲ). Conclusion Compounds Ⅰ-Ⅲ are isolated from C. tinctorius for the first time. Compound Ⅱ is a very important coenzyme for our bodies. It has been found that compound Ⅰ has the property of lowering the blood pressure of anesthetized dogs when administered in travenously.

Objective To explore the atypical ultrasonic appearances of breast fibroadenoma and analyze the cause of mis diagnosis.Methods A total of 493 lesions in 485 patients of breast fibroadenoma detected by ultrasound examination andconfirmed by pathology were retrospectively analyzed.Atypical appearances were analyzed and misdiagnosis rate were cal-culated.Statistical methods were taken to compare the misdiagnosis rates in lesions with various atypical appearances andthose with none or single atypical appearance.Misdiagnosis rates in lesions with different sizes and pathological types wereanalyzed statically.Then misdiagnosing causes were analyzed.Results A total of 404 lesions were diagnosed correctly,in-cluding 99 lesions with atypical appearances,and the other 89 lesions were misdiagnosed,which showed atypical appear-ances.The misdiagnosis rate of lesions with ≥2 atypical features was higher than that with none or single atypical feature(x2 =256.40,P＜ 0.05).Large lesions (maximum diameter＞ 3 am) showed higher misdiagnosis rates than small ones(maximum diameter ≤3 cm,x2=6.73,P＜0.05),and complex fibroadenoma lesions also showed higher misdiagnosisrate than simple ones (x2 =188.01,P＜0.05).Conclusion The lesions with various atypical appearances,large size andcomplex fibroadenoma in pathology are easy to be misdiagnosed.

BACKGROUND: Thermosensitive hydrogel has made great progresses in drug carrier and tissue engineering. However, its phase-transition temperature is lower than human body temperature, so it has not been used as implants. OBJECTIVE: To prepare and evaluate the biocompatibility of a thermosensitive hydrogel poly-(N-isopropylacrylamide-co-N-hydroxymethylacrylamide)[P(NIPAAm-co-NHMPA)] In vitro so as to assess its safety as a medical implant.DESIGN, TIME AND SETTING: Material experiment was performed at the Central Laboratory of Union Hospital of Tongji Medical College, Huazhong University of Science & Technology and Key Laboratory of Biomedical Polymers, Ministry of Education, Wuhan University Chemical Department from January to October 2007.MATERIALS: L929 mice fibroblast line was provided by Professor Chen, Stomatology Hospital of Wuhan University. N-isopropylacrylamide and N-hydroxymethylacrylamide were purchased from Aldrich.METHODS: Using ammonium persulfate and tetramethylethylenediamine as oxidateion-reduction initiation system and N, N'-methylene bisacrylamide as crosslinking agent, mass fraction 8.5% N-hydroxymethylacrylamide was added to the reaction system. The N-isopropylacrylamide and N-hydroxymethylacrylamide were dissolved in deionized water and reacted with N, N'-methylene bisacrylamide, ammonium persulfate and tetramethylethylenediamine at room temperature for 3 hours. The colorless transparent cylinder gel was obtained, soaked in deionized water and dried.MAIN OUTCOME MEASURES: Biocompatibility in vitro of the material was validated by cytotoxicity test, cells/scaffolds interaction test, hemolysis test and pyrogen test in vitro.RESULTS: Synthesized hydrogel showed thermosensitive character as expected and the lower critical solution temperature was 38 ℃. The toxicity rate was grade 0-1. Through the scanning electron microscopy, cells and scaffolds were tightly attached, producing a perfect interface, and the shape of cells was all right. Hemolysis rate was 2.54%. No pyrogen reaction was found. CONCLUSION: P(NIPAAm-co-NHMPA) has been successfully prepared with good biocompatibility in vitro and might become a good medical implant for clinical use.

Objective To investigate the role of p38 mitogen-activated protein kinase (p38MAPK) signaling pathway in reduction of myocardial ischemia-reperfusion (I/R) injury by morphine preconditioning in the rats with chronic heart failure in vitro.Methods Adult male Sprague-Dawley rats,weighing 200-230 g,aged 6-7 weeks,in which doxorubicin 2 mg/kg was injected via the tail vein once a week for 6 consecutive weeks to induce chronic heart failure,were studied.At the end of 8th week,30 rats with chronic heart failure were randomly divided into 5 groups (n =6 each) using a random number table:sham operation group (group Sham),I/R group,morphine preconditioning group (group MPC),SB203580 (p38MAPK inhibitor) + morphine preconditioning group (group SBM),and SB203580 group (group SB).The hearts were quickly excised and passively perfused in a Langendorff apparatus and subjected to 30 min of occlusion of the anterior descending branch of the left coronary artery followed by 120 min of reperfusion to establish the model of myocardial I/R injury.After equilibration,the hearts were subjected to 3 cycles of 5 min perfusion with K-H solution containing morphine 1 μmol/L at 5-min intervals before ischemia in group MPC.In group SBM,the hearts were perfused with K-H solution containing SB203580 (5 μmol/L) for 45 min starting from l0 min before morphine preconditioning until 5 min of ischemia.In group SB,morphine preconditioning was not performed,and the hearts were only perfused with K-H solution containing SB203580 (5 μmol/L) starting from 40 min before ischemia until 5 min of ischemia.At 15 min of equilibration (baseline),5 and 10 min of reperfusion,the coronary effluent was collected to detect the activity of lactate dehydrogenase (LDH) using the chemical colorimetry.At 10 min of reperfusion,the expression of phosphor-p38MAPK (p-p38MAPK) in the myocardium was determined by Western blot in Sham,I/R and MPC groups.At 120 min of reperfusion,the area at risk (AAR),total areas of right and left ventricles (LV+RV),and infarct size (IS) were measured,and the IS/AAR ratio was calculated.Results Compared with group Sham,the LDH activity in coronary effluent during reperfusion and IS/AAR ratio were significantly increased in the other groups,and the expression of p-p38MAPK was significantly up-regulated in I/R and MPC groups (P＜0.05).Compared with group I/R,the LDH activity in coronary effluent during reperfusion was significantly decreased,the expression of p-p38MAPK was significantly up-regulated,and the IS and IS/AAR ratio were significantly decreased in group MPC (P＜0.05),and no significant change was found in the LDH activity in coronary effluent,IS and IS/AAR ratio in SBM and SB groups (P＞0.05).Compared with group MPC,the LDH activity in coronary effluent during reperfusion was significantly increased,and the IS and IS/AAR ratio were significantly increased in group SBM (P＜0.05).Conclusion The mechanism by which morphine preconditioning reduces myocardial I/R injury is related to activation of p38MAPK signaling pathway in the rats with chronic heart failure in vitro.

Aim To illustrate the actions and molecular mechanisms of interventions taken to convert the metabolism pathways of cellular apoptosis caused by hypoxia and hypoxia-reperfusion in hypertrophic cardiomyocytes.Methods Angiotensin Ⅱ(0.1 ?mol?L-1)was applied to induce the hypertrophy of mice cardiomyocytes.The cardiomyocytes received the treatment of hypoxia-reperfusion in a tri-gas incubator to simulate the conditions of hypoxia-reperfusion.Before hypoxia/reperfusion,no drug intervention and pre-treatments of DCA(1 mmol?L-1),TMZ(5 ?mol?L-1),LC(50 ?mol?L-1)and AA(10 ?mol?L-1)were given respectively.The glucose and fatty acid oxidative metabolism rates were measured with radioactive counting methods.RT-PCR and Western blot methods were employed respectively to measure the mRNA and protein expression levels of cytochrome C and apoptosis inducers.The spectrophotometry method was used to measure the activity of Caspase-3 and Hoechst 33258 staining to quantify the percentage of cellular apoptosis.Results At post-hypoxia 12 h and post-reperfusion 4 h,the glucose oxidative metabolism rates in hypertrophic cardiomyocytes all decreased while the fatty acid oxidative metabolism rates increased.DCA,TMZ and LC all could inhibit both the reduction of glucose oxidative metabolism after hypoxia-reperfusion and the elevation of fatty acid oxidative metabolism after hypoxia-reperfusion.AA drove the reduction of glucose oxidative metabolism rate even lower and the fatty acid oxidative metabolism rate even higher in hypertrophic cardiomyocytes after ischemia/reperfusion.At the same time,DCA,TMZ and LC could inhibit the expression levels of mitochondrial cytochrome C and AIF mRNA and proteins,the nuclear translocation of cytochrome c and AIF proteins and the activity of caspase-3.And with the opposing actions to AA,DCA,TMZ and LC could inhibit the apoptotic rate of hypertrophic cardiomyocytes after hypoxia-reperfusion.And AA had the opposite effect.Conclusion Intervening in the metabolism pathway of hypertrophic cardiomyocytes was an effective way to prevent and control their programmed death through inhibiting the expression of mitochondrial apoptotic proteins.

AIM: To discuss the clinical efficacy of fresh amniotic membrane ( AM ) during the microscopic adjustable suture surgery in children's intercommunity strabismus, in order to guide clinical treatment.
METHODS: With the clinical randomized control study (RCT), 60 (112 eyes) cases of patients in childhood who received microscopic strabismus surgery in our hospital were divided them into two different groups from Jan. 2010 to Oct. 2015. According to the application of AM on the basis of ophthalmology outpatient number, 30 cases (58 eyes) in group A were treated with rectus muscle recession surgery combined adjustable suture combined with AM. The other 30 cases (54 eyes) in group B were treated with rectus muscle recession surgery combined adjustable suture only. All patients in two groups were followed-up over 6mo after the strabismus surgery.
RESULTS:Twenty-seven cases ( 48 eyes ) of all the strabismus patients must be adjusted after strabismus surgery, and the eye position adjustment rate was 42.9%. At 1mo after surgery, eye position of 18 cases (29 eyes) can be adjusted in all patients, and 44. 8% (16 cases, 26 eyes ) in group A with the average of adjustment lengths was 2. 56±0. 64mm, and 5. 6% ( 2 cases, 3 eyes ) in group B, with the average of adjustment lengths was 0. 52±0. 28mm, the differences of the adjustment rate and the average of adjustment amount were both high statistically significant (χ2 =22.477, P<0. 01; t=16. 502, P<0. 01 ) between the two groups. Except of 3 cases who couldn't cooperate with eye position adjustment, they all received eye position adjustment in different degrees in one month after strabismus surgery,and after eye position adjustment, 27 cases (53 eyes) in group A got normal eye position, and the correction rate of eye position was 91. 4%, and 16 cases (28 eyes) in group B got normal eye position after eye position adjustment, the correction rate was 51. 9%, the differences of the correction rate were statistically significant (χ2=21. 827, P<0. 01) between the two groups.
CONCLUSION: The application of fresh AM in the microscopic adjustable suture strabismus surgery is exactly effective in treatment of children's intercommunity strabismus. It can significantly extend the adjustment time and increase the adjustment amount, and it also can statistically improve the controllability and achievement ratio for children's strabismus surgery.

Objective To evaluate the value of echocardiography method for diagnosis of the downward displacement of the posterior leaflet of tricuspid valve with apical right heart two chamber view (AP-RH-2CV). Methods Rotating the probe clockwise from apical four chamber view(AP-4CV) to AP-RH-2CV at the septial and posterior leaflet of tricuspid valve, the shape, moving and position of the posterior leaflet of the tricuspid valve were observed by displaying the degree of downward displacement of the septial and posterior leaflet of tricuspid valve. The location of the orifice of tricuspid regurgitation was examined by color Doppler flow imaging(CDFI). Results In 15 patients with Ebstein's anomaly from the AP-RH-2CV, the downward displacement of posterior leaflet of tricuspid valve was clearly observed at the AP-RH-2CV. These results of echocardiography were confirmed by surgery except one ease missing out mild downward displacement of the anterior leaflet of tricuspid valve. Moreover, all 15 patients showed the obvious downward displacement of the location of the orifice of tricuspid regurgitation from AP-RH-2CV by CDFI. Conclusions The AP-RH-2CV is an ideal view in diagnosis of the downward displacement of the posterior leaflet of tricuspid valve by echocardiography. The downward displacement of the location of the orifice of tricuspid regurgitation is a critical character for diagnosis of the downward displacement of the posterior leaflet of tricuspid valve by CDFI.

Objective To improve the nursing skills of low age and service seniority nurses and meet the needs of clinical nurses,in order to serve patients better and improve the quality of cave.Methods According to knowledge tests 50 points for nurse job-related skill issued by Chinese Ministry of Health,our hospital selected 12 commonly used basic operation skills and designed comprehensive cases through integration and reformation.We trained and examined nurses with undergraduate degree came to our hospistal in 2008.Results After training,the score of clinical nursing skill reached 91.81,86 nurses reached the standard and the effective compliance rate was 95%.Conclusions It proved to be an effective method to improve the nursing skills of low-age and service seniority nurses by carrying out the comprehensive casestyle training methods.

Objective To establish a multiple regression equation of long delayed recall of the amnestic mild cognitive impairment,in order to predict the scores.Methods 248 old people were investigated by convenience sampling.Auditory verbal learning test (AVLT) was used to evaluate the ability of memory of the old people,and their general demographic data were collected.Multivariate linear regression analysis was conducted,the regression model was established and AVLT-long delayed recall scores (N5) to the predicted value got from the 3 times scores of study stage scores (N1,N2,N3) and short delayed recall (N4) of Auditory Verbal Learning Test were compared.Results The multiple linear regression equation between the variables was established.There was no significant difference between N5 and the predicted value.Conclusions N2,N3,N4 could be used to predict N5 during screening of amnestic mild cognitive impairment to make the screening process faster and briefer.When the score ≤4 points,the screening continues,if the score ＞5 points,the screening ceases in order to improve the efficiency of screening.