Objective: To investigate the change of the micro- and ultramicro-structure of in- trahepatic bile duct after liver graft and the protection of hypoxic preconditioning. Methods: The model of orthotopic autologous liver transplantation was used, thirty SD rats were randomly divided into three groups. A: orthotopic autologous liver transplantation group; B: hypoxic preconditioning before operation group; C: sham operation group. The serum bilirubin ,the micro-structure of biliary epithelial cell and the ultramicro-structure of cholangiole were determined in three groups after 48hours after operation. Results: As compared with B group: the serum bilirubin increased (P

Objective To evaluate the effectiveness of applying simulation based medical education (SBME) in critical care medicine PBL teaching. Methods Totally 46 undergraduates in medical college of Shanghai JiaoTong University , who participated in critical care medicine PBL teaching in our Hospital from 2012 to 2013 were chosen as research objects. These students were divided into two groups: PBL group (2009 grade, n=24) and SBME-PBL group (2010 grade, n=22). The teaching effectiveness was evaluated by questionnaire survey, theoretical exam, direct observation of procedural skills (DOPS) and mini-clinical evaluation exercise (Mini-CEX). Data were analyzed by SPSS 17.0 software. The data of questionnaire survey were expressed as percentage and the assessment results were expressed as x±s. Chi-square and t test were used to do statistical analysis. P<0.05 signi-fies for statistically significant differences . Results ①The results of questionnaire survey showed that:there was no significant difference between two groups in study interests(P=0.665, 0.937, 0.746) and study ability(P=0.937, 0.665). But regarding collaboration ability, SBME-PBL group performed better than PBL group (P=0.019, 0.038, 0.024). ②These was no significant difference in the theo-retical knowledge exam between PBL and SBME-PBL group(P=0.743). But the DOPS scores of car-diopulmonary resuscitation (P=0.000), endotracheal intubation (P=0.023), defibrillation (P=0.002) and central venous catheterization(P=0.047) were all significantly higher in SBME-PBL group than in PBL group. ③In Mini-CEX, there was no statistical difference in physical examination skills (P=0.790) and clinic judgment(P=0.426) between the two groups. However, SBME-PBL group performed better in medical interviewing capacity(P=0.002), humanistic care (P=0.001), counseling skills(P=0.017), organization efficiency(P=0.029) and overall clinical competence(P=0.024) than PBL group. Conclusions SBME can promote the students' team work spirit, basic clinical skills and comprehen-sive clinical capacity in critical care medicine PBL teaching and can improve the teaching quality of critical care medicine.

Adolescent ; Adult ; Child ; Child, Preschool ; Choristoma ; metabolism ; pathology ; surgery ; Encephalocele ; metabolism ; pathology ; surgery ; Female ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Infant ; Male ; Meningocele ; metabolism ; pathology ; surgery ; Middle Aged ; Mucin-1 ; metabolism ; Neuroglia ; metabolism ; pathology ; Nose Diseases ; metabolism ; pathology ; surgery ; S100 Proteins ; metabolism ; Vimentin ; metabolism ; Young Adult

OBJECTIVEChinese herbal medicine has been extensively used in the treatment of vascular dementia (VaD), but lacked systematic review on its efficacy and safety. So we conducted a systematic review to assess the efficacy and safety of Chinese herbal medicine in treating VaD.

METHODSCNKI, CBM, PubMed, and Wiley Online Library were retrieved for randomized trials (RCTs) on Chinese herbal medicine treating VaD patients. Randomized parallel control trials by taking Chinese herbal medicine as one treatment method and placebos/cholinesterase inhibitors/Memantine hydrochloride as the control were included. Quality rating and data extraction were performed. RevMan5.2.0 Software was used for meta-analysis. Standardized mean difference (SMD) at 95% confidence interval (CI) was used to indicate effect indicators of results.

RESULTSSeven RCTs met the inclusive criteria. Totally 677 VaD patients were randomly assigned to the treatment group and the control group. Descriptive analyses were performed in inclusive trials. The cognitive function was assessed in all trials. Results showed Mini-Mental state examination (MMSE) score was better in the Chinese herbal medicine group than in the placebo group, but with no significant difference when compared with the donepezil group (P > 0.05). Adverse reactions were mainly manifested as gastrointestinal symptoms such as abdominal pain in the Chinese herbal medicine group. But they occurred more in the donepezil group than in the Chinese herbal medicine group.

CONCLUSIONSThe methodological quality of included trials was poor with less samples. Results of different trials were lack of consistency. Present evidence is not sufficient to prove or disapprove the role of Chinese herbal medicine in improving clinical symptoms and outcome indicators of VaD patients. Their clinical efficacy and safety need to be supported by more higher quality RCTs.

Complementary Therapies ; Dementia, Vascular ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Indans ; therapeutic use ; Piperidines ; therapeutic use ; Randomized Controlled Trials as Topic

OBJECTIVE To study the drug resistance,drug-resistant genes and(disinfectant)-resistant genes of(MRS)A.METHODS The drug resistance and mecA gene of the ?-lactamase and aac(6′)/aph(2″),aph(3′)-Ⅲ,ant(4′,4″) genes of aminoglycoside and qac(A/B) disinfectant-resistant genes were(detected) in 47 strains of MRSA.(RESULTS) In all 47 strains of MRSA,46 MRSA isolates were mecA positive,39 MRSA isolates were aac(6′)/aph(2″) positive,30 MRSA isolates were aph(3′)-Ⅲ positive,6 MRSA isolates were ant(4′,4″) positive,and 19 MRSA isolates were qac(A/B) positive.CONCLUSIONS MRSA is multiple-drug resistant.The main resistant mechanisms of MRSA to aminoglycosides and disinfectant are related to the drug-resistant genes of aminoglycoside and disinfectant-resistant genes.Clinic physician must pay attention to the diagnosis and(therapy) of MRSA,and control the hospital infection.

Objective: To evaluate the diagnostic performance of conventional ultrasound, compression elastography (CE) and acoustic radiation force impulse imaging (ARFI) in diff erential diagnosis of benign and malignant breast tumors. Methods: A total of 98 patients with liver lesions were included in the study. The images of conventional ultrasound, CE and the values of virtual touch tissue quantiifcation (VTQ) of breast lesions were obtained. hTe diagnostic performance of conventional ultrasound, CE and ARFI were assessed by using pathology as the gold standard, and then evaluate the diagnosis effciency of these three approaches in differential diagnosing benign and malignant breast tumors. Results: The specificity, sensitivity and accuracy in the diagnosis of malignant breast tumors for conventional ultrasound were 80.0%, 81.1% and 81.7%, respectively, whereas for CE elastic score were 85.7%, 86.7% and 86.3%, respectively. With a cutoff value of 3.71 for the SR, the sensitivity, speciifcity, accuracy in diagnosis of malignant breast tumors were 97.1%, 83.3% and 88.4%, respectively. With a cutoff value of 3.78 m/s for VTQ, the sensitivity, speciifcity, accuracy in diagnosis of malignant breast tumors were 94.3%, 91.7% and 92.6%, respectively. The difference in diagnosis efficiency among ARFI, CE and conventional ultrasound in differential diagnosis of benign and malignant breast tumors was signiifcant (P<0.05). Conclusion: Conventional ultrasound, CE and ARFI are all useful for the differential diagnosis of benign and malignant breast tumors. But the diagnosis effciency of ARFI is superior to CE and conventional ultrasound. The three approaches can help each other in differential diagnosis of benign and malignant breast tumors.

AIM:Toinvestigatewhetherautophagyisup-regulatedwhenresveratrol(Res)inducesapoptosis in chondrosarcoma , and to study the effects of autophagy inhibitor combined with Res on chondrosarcoma .METHODS:SW1353 cells were divided into 4 groups: control group, Res group, 3-methyladenine (3MA) group, and Res +3MA group.Electron microscopy was used to observe the autophagyosomes in control group and Res group .At the same time, the viability of the cells in the 4 groups was detected by CCK-8 assay.TUNEL staining and Western blotting (for determi-ning the levels of cleaved caspase-3, Bax and Bcl-2) were used to reflect levels of apoptosis in all groups .The expression of autophagy-related proteins Beclin 1, LC3-Ⅱ and p62 was detected by Western blotting .RESULTS: Exposure of the cells to Res resulted in a decrease in cell viability and an increase in the level of apoptosis ( P<0.05 ) .Compared with control group, the level of apoptosis was increased but the autophagy was decreased (P <0.05).Compared with Res group, the cell viability and the level of autophagy were decreased and the level of apoptosis was increased ( P<0.05 ) . CONCLUSION:Resveratrol induces apoptosis and autophagy , and inhibition of autophgay enhances resveratrol-induced apoptosis in chondrosarcoma .

Objective To study the prognosis of gastroesophageal reflux disease ( GERD) in children, and explore the factors which impacts on the prognosis of GERD. Methods One hundred and thirteen children with GERD were enrolled on the basis of positive result of 24-hour pH-monitoring between January 2007 and November 2011. The number of patients who were followed up was 87,and the parents of children were contacted with the telephone. The prognosis was evaluated by comparing the degree of patients′symptom relief,and the cumulative symptom relief rate was calculated by Kaplan-meier product limit method. The univariate Log-rank test and the COX proportional hazardmodel multivariate analysis were applied to detect the factors impacting on the prognosis,including age,gender,the regularity of treatment,reflux index,and Boix-Ochoa standard score,with esophageal hiatal hernia or without,receiving surgical treatment or not,the diet and lifestyle improved or not,receiving anti-acid treatment or not,as well as with allergies his-tory or without. Results At last,76 out of 87 children had symptom relieved. Survival curve showed the cumulative symptom relief rate at different time points,the median cumulative symptom relief rate reached 6 months,the final relief rate was close to 90. 0%,and the continuous treatment time was 44 months. The study showed that 14. 9% (13/87 ca-ses) of children′s growth and development were affected and the life and learning in 16. 1% (14/87 cases) of children were impacted. Age (P=0. 012,Wald=6. 376) and the regularity of treatment (P=0. 000,Wald=13. 059) were the risk factors in the prognosis of GERD. Conclusions Age and the treatment regularity were the factors in the prognosis. The children aged more than 1-year old have poor prognosis compared with those less than 1-year old,and the irregular treatment is the risk factor in the prognosis.

Objective To analyze the emergercy epidemiological characteristics of coeualties with head in-jury in Shanghai. Method By a prospective study,the data of 18 076 casualties with head injury during the whole year 2004 collected from 12 joint hospitals in Shanghai were documented well in the unified survey tables with wide-range items failed in by the attending physician, who got the firsthand information from patients and witness.The data were analyzed by using SPPS version 11.5 software. Results Of 18 076 casualties with head injury,the ratio of male to female was 2.11: 1.The mean age of female was older than that of male (t=10.575, P<0.01).The highest incidence of casualties occurred in people of twenties (24.7 % ). The local residents of Shanghai ac-counted for 34.2% of casualties. More casualties often occurred in December,January,Mareh and August than in he rest. Of 5.1% casualties with head injury were assochted with labour work.The leading cause of injury was dif-ferent in patient cohorts of different ages. Fall was the most main cause of trauma in children cohort (aged<14)and the senile patients cohort (aged > 60). The violert assault and traffic accident caused the most head injuries in the adolescent people cohort ( aged 15～34 years old) and the young people cohort ( aged 35～59 year old). The majority of casualties (85.5%) received CT scan.The scalp laceration (40.2% of patients) was seen more often than other types of injury . The mortality of easualties with traumatic brain injury was 0. 5 % . Conclusions The kmowledge of epidemiologieal aend of emergency deparhnent visitors with head injury is amportant guidance to physicians arranging emergency medical resources rationally and formulating a comprehesive prevention stategy of castahies with head injury.

Objective To evaluate the tolerance and safety of sorafenib for elderly patients with advanced renal cell carcinoma.Methods Forty cases with advanced renal cell carcinoma were enrolled,26 were males and 14 were females,the average age was 70 years.Recurrence or metastasis was found in 32 patients who had received nephrectomy,22 of the 32 cases had received cytokine therapy before recurrence or metastasis.Primary renal lesions of 8 cases could not be resected,so patients get renal tumor biopsy.Pathological type of all patients was clear cell carcinoma.KPS of all the patients were ≥70 points.Sorafenib was used as first-line treatment,with 400 mg twice per day,until intolerance or disease progression occurred.Results The average treatment time was 7.5 months (3-18 months),CR 0 case,PR 6 cases,SD 29 cases,PD 5 cases.The overall objective response rate and disease control rate were 15.0% (6/40)and 87.5%(35/40),respectively.The median follow-up period was 11 months.The adverse reaction included hand-foot skin reaction(70.0%),alopecia (62.5%),rash(52.5%),diarrhea(37.5%),loss of appetite(32.5%),fatigue(27.5%).Most adverse reactions occurred around the second week after drug therapy initiation,their duration did not equal.And most of these adverse reactions could be released by symptomatic treatment,they did not affect the treatment.Conclusions The types of adverse reactions of sorafenib for elderly patients with advanced renal cell carcinoma are similar to those reported in the literature.Generally the degree of adverse reactions is minor,with good tolerance and safety.