After the tissue injuries appear,bone marrow mesenohymal stem cells(MSCs)migrate to the lesion place against the chemokine concentration gradient and produce natural compensatory repair by differentiation of the injured cells,immunological regulation and paracrine of various cytokines,such as hepatocyte growth factor(HGF).HGF is one of the important chemokine factors of MSCs.It can inhibit proliferation of MSCs and induce MSCs into hepatocytes and epithelial cells.However,the mechanisms of MSCs on the injured tissue repairing are complicated,and the underlying mechanism consists of homing to the injured lesion,correct oriented differentiation of local micrcenvironment and in inhibition on the host immunity.With the deeperresearch,the mechanism of reparative process MSCs acting on damaged tissue will be elucidated gradually.It may be helpful for the instruction of the clinical treatment to engraft MSCs which are modified with effective genes and to enhance the ability of ceil engraftment.

The application of multimedia technology in the teaching of TCM Features Science has intuitive, figurative, scientific and interactive advantages, which makes the teaching course simple and easy to operate, and enables a knowledge-point described from multi-channel, multi-angle and multi-dimension. Thus the students can analyze a question from many respects, deepen their understanding ability, realize the optimization of the teaching process, and improve the effectiveness of the teaching results.

Objective The main objective of this study is to explore the effect of liver function on the awake BIS value.Methods According to the Child-Pugh classification,65 patients were divid-ed into three groups.Group A (n=27):patients with normal liver function;group B (n=21):pa-tients with Child-Pugh A;group C (n=1 7):patients with Child-Pugh B-C.The awake BIS value at rest was measured.Results Total bilirubin (TBIL),direct bilirubin (DBIL),indirect bilirubin (IBIL),alanine aminotransferase (ALT),aspartate aminotransferase (AST),albumin (ALB)of group B and C were significantly poorer than group A (P <0.05 or P <0.01).The coagulation func-tion of group C was poorer than group A and B (P <0.01).Compared with group A (96.2 ± 1.7) and group B (95.6±0.8),the awake BIS value of group C (94.1±3.0)was significantly reduced (P<0.01).The awake BIS value was negatively correlated with the TBIL value (r = - 0.26,P =0.039).Conclusion The awake BIS value in end-stage liver disease patients was significantly lower than that in patients with normal liver function and mild liver dysfunction.The awake BIS value may be related with the amount of total bilirubin in the blood.

The theory of Constructivism was applied in different aspects of clinical teaching of surgery.The lessons were designed according to the character of students.Problem solving was emphasized during the course of teaching.An interactive and cooperative atmosphere was constructed.And a variety of additional related materials were provided.All these measures made the teaching activity more accord with the objective rule of clinical knowledge learning.Hence a better teaching effect was achieved.

To improve the teaching quality of advanced students on minimally invasive surgery is important for the generalization of new techniques on this subject.The teaching plan should be made according to the academic level of these students.Both theory learning and clinical practice should be emphasized.Multimedia tools should be adopted and English teaching should not be neglected.All these means help to better the teaching quality of advanced students on minimally invasive surgery.

A hospital big data-based innovative diagnosis and treatment decision-making support model ( Info Button) was proposed for grass-root medical institutions in Sichuan Province in view of uneven distribution of its medical resources and of beingdifficult and expensive to see a doctoraccording to an analysis of the major health information projects and health information management.How to construct the model was elaborated with its problems pointed out.

Objective To analyze and evaluate the current progress of blood transfusion department establishment and clinical blood transfusion management in Hangzhou,China.Methods Questionnaires were sent to 35 medical institutions to gather information regarding blood transfusion department establishment and clinical blood transfusion management in the provincial,municipal and county tier hospitals.The investigated criteria covered the establishment of the hospital blood transfusion management committee,the utilization of software and hardware of the transfusion department,the compatibility status of various software systems in use and performance evaluation of these systems in clinical applications,etc.In addition,tests were also conducted on members of the blood transfusion departments to confirm whether they are properly trained and present adequated knowledge of clinical blood applications Results were then collected for statistical and descriptive analyses.Results The results out of the 35 hospitals surveyed presented no obvious statistical significance.Nevertheless,the average score of these hospitals in different segments helped us to reach the following conclusions:1,Triple-A hospitals scored the highest average score for patient clinical status evaluation pre-transfusion;2.Double-B hospitals came first when it comes to patient clinical status evaluation post transfusion;3.Triple-B hospitals possessed the most thorough clinical records for transfusion treatment.A total of 350 papers were issued and 350 papers were collected,with 327 out of the 350 considered valid.As for the test results regarding the departments members,triple-A,triple-B and double-A hospitals scored significantly higher than double-B and unranked hospitals.(P＜0.05);.350 clinical transfusion records were also collected and 247 of which are considered valid.It appears there are numerous difference in Hb indexes among the tested hospitals and even the departments of internal medicine and surgical presented different takes on the subject as well.Conclusion The clinical blood transfusion management in Zhejiang province and the establishment of blood transfusion departments still need to be improved.A plan to manage clinical blood use need to be carried out ASAP,which would specify evaluation references,standardize personnel training and tech investments.Ultimately,we hope such actions would help to further regulate the clinical blood use in the region.

Objective To investigate the predictive values of P-selectin (P-sel),thrombus precursor protein (TpP) and D-dimer (D-D) in the early diagnosis of portal vein thrombosis (PVT) in patients submitted to splenectomy (or to devascularization).Methods The clinical data of 48 patients with portal hypertension (the PVT group,n=26; and the non-PVT group,n=22) who received operation in our hospital from 2009 to 2011 were retrospectively analyzed.Detecting the P-sel,TpP and D-D levels in the two groups of patients were done on preoperative day 1 and postoperative day 1,3,5,7,14.The SPSS software was used for statistic analysis.Results There were no significant differences on the preoperative day 1 levels of P-sel,TpP and D-D in the two groups (P＞0.05).The postoperative day1 levels of the three indicators in the PVT group were significantly higher than the non-PVT group (P＜0.05).Receiver operating characteristic (ROC) curves showed the area under curve (AUC) of P-sel was largest (0.893),followed by D-D,and TpP.The combined detection of the 3 indicators was highest,with the AUC up to 0.977.Conclusions Combined detection of P-sel,D-D and TpP levels were useful in the early diagnosis of PVT after splenectomy in patients with portal hypertension.

Objective: To analyze the influencing factors for residual lesions after radiofrequency ablation in elderly patients with liver cancer. Methods: Clinical data of 65 elderly patients with liver cancer treated by radiofrequency ablation in our hospital from January 2014 to December 2016 were retrospectively analyzed.The influencing factors on residual lesions after radiofrequency ablation were analyzed by univariate analysis and multivariate logistic regression. Results: Of 102 lesions in 65 elderly patients with liver cancer, 87 lesions were completely ablated at the first time, and the first complete ablation rate of lesion was 85.29%(87/102). All visible lesions were completely ablated in 56 patients at the first time, and the first complete ablation rate of cases was 86.15%(56/65). Fifteen lesions in 9 patients were incompletely ablated.Univariate analysis showed that gender(χ²=0.740, P=0.390), cirrhosis(χ²=0.745, P=0.388), hepatitis B(χ²=0.057, P=0.812)and type of liver cancer(χ²=0.171, P=0.682)had no significant effect on the residual lesions after radiofrequency ablation, but the number of lesions(χ²=6.694, P=0.010), the lesion size(χ²=14.382, P=0.000)and liver function classification(χ²=5.359, P=0.030)had statistically significant effects on residual lesions after radiofrequency ablation.Further multivariate logistic regression analysis showed that the number of lesions ≥ 3(OR=1.916, 95%CI: 1.326~2.571, P=0.029), the size of lesions≥3 cm(OR=2.362, 95%CI: 2.180~2.923, P=0.000)were risk factors for residual lesions after radiofrequency ablation. Conclusions Radiofrequency ablation has a better therapeutic effect on liver cancer in elderly patients.The number and size of lesions have a certain impact on the residual lesions after radiofrequency ablation.

Objective:To evaluate the effect of early mobilization on mortality in intensive care unit (ICU) patients with mechanical ventilation after discharge by Meta-analysis.Methods:Databases including SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang data, PubMed, the Cochrane Library, Web of Science, and Embase were searched from inception to September 17th, 2020, to collect randomized controlled trials (RCT) about early mobilization on mortality of patients with mechanical ventilation in ICU after discharge, the references included in the literature were traced. The control group was given routine care, the experimental group was given early mobilization on the basis of the control group, including passive or active mobilization on the bed, sitting on the bed, standing by the bed, transferring to the bedside chair and assisting walking. The literature screening, data extracting, and the bias risk assessment of included studies were conducted independently by two reviewers. Stata 12.0 software was then used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 10 RCT studies involving 1 323 patients were included, with 660 patients in the control group and 663 patients in the experimental group. The results of literature quality evaluation showed that 7 studies were grade A and 3 studies were grade B, indicating that the overall quality of included literatures was high. The Meta-analysis results showed that early mobilization did not increase the mortality of patients with mechanical ventilation in ICU after discharge [odds ratio ( OR) = 0.92, 95% confidence interval (95% CI) was 0.75-1.13, P = 0.449]. Subgroup analysis results showed that early mobilization had a tendency to reduce the mortality of ICU patients with mechanical ventilation at 3, 6 and 12 months after discharge, but the difference was not statistically significant (3-month mortality: OR = 1.02, 95% CI was 0.74-1.40, P = 0.927; 6-month mortality: OR = 0.95, 95% CI was 0.70-1.27, P = 0.712; 12-month mortality: OR = 0.60, 95% CI was 0.33-1.10, P = 0.101). Funnel plot showed that the distribution of included literatures was not completely symmetrical, suggesting that publication bias might exist. Conclusions:Early mobilization does not increase the mortality of ICU patients with mechanical ventilation after discharge. Although it tends to have a favorable outcome in reducing mortality, and has a trend to reduce the mortality. However, due to the small number of included literatures, small sample size and differences in the specific implementation of early mobilization among various studies, a large number of high-quality RCT studies are still needed for further verification.