Purpose:To eveluate the effect of liver function after TIPSS.Materials and methds:Ananalysis of 17 cases with laboratory data to study the liver function changes after TIPSS (transjugular intrahepatic portosystemic stent shunts).Results:There were 35 percent of cases whose liver function were worse than before,the others showed no change or better after TIPSS. Couclusion:It was important to choose the cases strictly before TIPSS so as to reduce the compli- cation and improve the survival rates.Although some cases liver function went worse after TIPSS but only temporarily.TIPSS can reduce bleeding retes effectively,thus simultaneously seve the lives.It is worthy to extend this procedue.

Objective:To investigate the problems and improve the quality of clinical education.Method:A questionnaire was made among 200 medical students at Ji'ning medical college.Results:About eighty-eight percent of the students were satisfied with their clinical education,but there were still some problems:absence of clear objectives in clinical practice;shortage of enthusiasm of the students;lack of responsibility of some teachers and too many factors affecting clinical practice.Conclusion:The key points to improve clinical education quality are to set up clear education objectives,develop appropriate clinical practice methods,improve teaching staff quality and reform the teaching content.

Objective To study the 6 year outcome following transjugular intrahepatic portosystemic shunt (TIPSS) for variceal bleeding due to portal hypertension. Methods 65 patients, 51 males, 14 females, aged 35～72 years old with averaged 4.5 years, have been undergone TIPSS because of portal hypertension due to cirrhosis or Budd Chiari syndrome. The portal pressures were measured before and after TIPSS. Follow up study was done by color Doppler sonography or Barium esophageal radiogaphy for 3 months to 6 years (averaged 18 months). Repeated interventional treatments were done in cases of restenosis of the shunts. Results There were 0,2,10,5,0 cases of recurrent bleeding after 3 months, 6 months, 1 year, 2 year and 3—6 year following TIPSS respectively. Stenosis occurred in shunt paths due to thrombosis or smooth muscle cell proliferation or neointimal hyperplasia were relieved after thrombolytic therapy and repeated balloon angioplasty or stent plant among most of them. 2 were failed due to serious stenosis. 7 cases died, 2 of massive bleeding, 1 of the other cause and 4 of hepatic cancer. The other patients are getting well. Conclusions Although there were very high rates of restenosis (34%), but most of them could be treated again with interventional therapy, and in kept patency effectively. TIPSS is a still practical valuable management for massive gastric bleeding.

Objective To explore the imaging diagnostic method of Merkel cell carcinoma(MCC). Methods Imaging and pathologic features of MCC of 1 female and 44 years old patient were determinded by CT, MRI, pathologic examination and operative observation. Results MCC is a rare subepidermal carcinoma, and most located in the head, neck region and extrimities. Clinically, only a presumptive diagnosis of MCC can be established. The definite diagnosis of MCC can be made only by pathologic examination, especially immunohistological method. MCC is red and brown, and looks like rotten meat. MCC texture is middle with rich blood supply. MCC can invade occipital bone, occipital muscles, dura and cerebellar tissues. Optical microscope observation showed that MCC is located at dermis, and sometimes at subcutaneous tissues. MCC cells are gathered in groups, their sizes are unanimous, and their shapes look like lymphocytes. The cell nuclei of MCC looklike empty bubbles, and have many karyokinesis. The chromatin of MCC is very fine. The cytoplasms of MCC are little, and oxyphil staining. Immunohistological staining showed that both NSE (neuron-specific enolase) and CK(cytokeratin) are positive. The CT imaging of MCC is higher density. The MRI imaging of MCC is lower signals with unclear border in T1w and T2w, but becomes clear in enhanced MRI. Tumor cells invasion to soft tissues and bones could be seen on CT or MRI. Conclusion CT and MRI could clearly show the characteristics of MCC, and provide valuable information for operative treatment of MCC.

Objectives To explore the clinical effect of coupling meglumine cyclic adenylate (MCA)and the human granulocyte colony-ostimulating factor (G-CSF)on rat with diastolic heart failure(DHF).Methods Totally 60 rats of DHF model were evenly divided into 4 groups according to random number:Control group(n=15,control),Model group(n=15,DHF model),MCA group(n =15,treated with MCA)and MCA+GCSF group(n=15,treated with MCA plus G-CSF).MCA group were administered by intragastric injection of MCA 30 mg/kg/d for 15 d,MCA+G-CSF group were administered by intragastric injection of MCA 30 mg/kg/d and plus G-CSF 100 μg/kg/d for 15 d,while Control group and Model group were given same volume of saline solution.BIOPAC SYSTEM was used to analyze the model establishment.The mRNA levels of GATA-4 and Cx43 were measured by RT-PCR.The protein expressions of GATA-4,Cx43,cTNI and c-kit were measured with western blotting.ELISA and flow cytometry were used to detect cAMP and differentiation rate of bone marrow mesenchymal stem cells (BMSCs),respectively.Results Compared with MCA group,the denaturation degree of myocardial tissues in DHF rat was significantly improved than in MCA+G-CSF group.Moreover,the level of GATA-4 (1.62 ± 0.09),Cx43 (1.02 ± 0.07),cTNI (1.42 ± 0.12),c-kit (0.65±0.02),cAMP(283.67± 18.09)nmol/L and BMSCs cell differentiation rate(38.62 ± 1.52)％ in MCA + GCSF group were significantly promoted (all P＜ 0.05)than in MCA group,GATA-4 (0.82±0.07),Cx43 (0.52±0.05),cTNI(0.86 ± 0.13),c-kit (0.48 ± 0.03),cAMP(198.83 ± 16.03) nmol/L and BMSCs cell differentiation rate (19.82 ± 0.89)％.Conclusions The combination of MCA with G-CSF is significantly improved DHF than single MAC treatment,which may regulate BMSCs differentiation though cAMP/PKA signaling pathways.

Objective To explore the status and impact factors of hospitalized patients with coronary heart disease(CHD) accompanying depression disorders.Methods Adopt HRSD,SDS and general questionnaire for survey tools to evaluate the 300 hospitalized patients with CHD.Using SPSS13.0 software to build database,and the data was analyzed by descriptive statistics analysis and correlation analysis.Result There were 148 people accompanying depression disorders among the hospitalized·patients with CHD(47.30％ ),and 68 people were treated (47.89％).Multivariate logistic regression indicated that the age ( OR =-0.415,P ＜ 0.05,CI =0.443 ～0.984),smoking history( OR =0.384,P ＜ 0.05,CI =1.118 ～ 1.928 ),course of disease ( OR =-0.250,P ＜0.05,CI =0.608 ～ 0.996),myocardial infarction ( OR =0.676,P ＜ 0.05,CI =1.082 ～ 3.576 ),family history ( OR =-0.744,P ＜ 0.05,CI =0.231 ～ 0.978 ) were related to coronary artery disease accompanying depression disorders.Multivariate correlation analysis indicated that anxiety factor and gender were closely related,weight factor and age,educational level,myocardial infarction had closed relationship,cognitive factors were closely associated with the course of disease,day and night changes were in relation to age,block factor and gender,age,education,drinking history,smoking history were related closely,sleep factor and gender,onset form,hypertension relations closed,despair factor have closed relationship with gender,age,educational level,course of disease.Conclusion Age,smoking history,course of disease,myocardial infarction,family history were important risk factors of depression disorders in hospitalized patients with CHD.The HRSD's seven symptoms factors are closely associated with multipling influence factors.

Objective To further investigate the relationship between apolipoprotein E(APOE) genotype and trait anxiety in patients with coronary heart disease (CHD).Methods Use the state-trait anxiety inventory (STAI) to investigate the state anxiety and trait anxiety of 107 CHD patients.According the score of TAI,the CHD patients were divided into CHD with high trait anxiety group ( n=39)and low trait anxiety group(n=68).The genotypes and alleles of apolipoprotein E gene was detected in all CHD patients and 50 healthy control subjects with the polymerase reaction(PCR) and restriction fragment length polymorphisms(RFLP) technique.Correlation analysis and logistic regression analysis were used.Results Apolipoprotein E gene showed positive relationship with trait anxiety score( OR =9.251,95％ CI2.726 ～ 18.266).F4 allele entered the regression equaltion Y =30.252 + 0.048X3 (P ＜ 0.05 ).Conclusion The results suggest the polymorphisms of Apolipoprotein E e4 allele may be associated with the trait anxiety symptom.

Objective To study the impact of depression disorder in patients after coronary stent implantation on incidence rate of in-stent restenosis (ISR) in the coronary heart disease( CHD ), and its possible pathophysiological mechanisms. Methods According to the Hamilton Depression Scale (HAMD-24) and Self-rating Depression Scale(SDS) score,95 patients with unstable angina received coronary drug-eluting stent implantation combined with depression disorder were serve as the study group; randomly selecte 246 cases without depression due to unstable angina pectoris after coronary stent implantation as the control group in the same period. The incidence rate of ISR in these two group were observed, and serum aldosterone ( ALD), high-sensitivity C-reactive protein (hs-CRP) ,Leptin levels in two groups were compared. Results The incidence rate of ISR in study group were significantly higher than that of the control group (28/95 vs 46/246, P＜0. 05). Following with the aggravation of depression disorder,the incidence rate of ISR were elevated( χ2 =8. 148, P=0.017). Serum ALD,hs-CRP and Leptin levels of study group were significantly higher than the control group 7 days later after drug-eluting stent implantation ( ALD:277.4 ± 35.9 vs 258.9 ± 60.9, t= 3. 459, P= 0. 001; hs-CRP: 12.03 ± 3.06 vs 11.10 ±2. 806, t = 2.573, P = 0.008; Leptin:5.27 t 1.07 vs 4.98 ± 0.99, t= 2.323, P= 0.021 ). Pearson correlation analysis showed that its HAMA-24 score was positively correlated with serum ALD ,hs-CRP and Leptin( r=0.291,P=0.026; r=0.350, P=0.014; r=0. 312, P=0.023) ,and SDS score was positively correlated with hs-CRP( r=0. 302, P= 0. 020). Conclusion Serum ALD, hs-CRP and Leptin levels are higher in patients after coronary stent implantation combined with depression in patients, and the incidence rate of ISR is also higher in these patients, and the rates are elevated according to the aggravation of depression disorder.

Objective To explore the effectiveness and safety of fiberbronchoscope combined with cryotherapeatic equipment in treatment of bronchial foreign body in children.Methods 72 children with bronchial foreign body received fiberbronchoscope combined with cryotherapeatic equipment, then the complications were observed during and after the operation.Results Bronchial foreign bodies were successfully removed in all the patients. Among the 72 cases, transient hypoxia was the most common complication during the operation which happened in 37 cases and most occurred in the small age group, and decreased with the age increasing; cough or worsening of cough was the most common complication after the operation which happened in 20 cases; No serious complications were found during the follow-up.Conclusion Although it has some complications when bronchial foreign body received the fiberbronchoscope combined with cryotherapeatic equipment, but the operation time is short, and the complication is mild. It has great application value and security.

Objective To investigate the influence of acpuncture on free calcium in rat brain cells after focal cerebral ischemia reperfusion.Methods 145 adult male SD rats were randomly divided into control group,simple ischemia reperfusion group and acupuncture with ischemia reperfusion group.The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model was established by the modified Longa occlusion method. ①The part of free calcium in rat brain cells,focal cevebral ischemia model of rats were made by thread locking up the blood vessel for 15 min.30 min later after reperfusion, the Baihui and Shuigou Point in Du meridian were acupunctured electrically 30 min.After 3h, 6h and 12h, the rat was killed and its brain cells were made into single cell suspension,marked by Fluo-3/AM.The fluorescence optical density was recorded by laser confocal microscopy.②The part of nerve functional reconstruction, focal cevebral ischemia model of rats were made by thread locking up the blood vessel for 12 hours.30 min later after reperfusion, the Baihui and Shuigou Point in Du meridian were acupunctured electrically 30 min.After 7 d, 14 d,30 d,60 d and 90 d, the rat was forced to detect it's strength of the dog.Results ①Free calcium in rats of acupuncture therapy group(6h:10.96±1.18;2h:20.9±4.37) was significantly less than that in control group in 6 h and 12 h after reperfusion (6 h: 16.87 ± 3.56,12 h: 34.10 ±1.06)(P<0.05).②The dog in rats of acupuncture therapy group was significantly more than that in control group in 7 d, 14 d after reperfusion (P＜ 0.05 ).No difference of the dog was detected in 30 d ,60 d and 90 d after reperfusion between the two groups.Conclusion Acupunture could decreases the concentration of free calcium and the expression of Caspase-3 mRNA in rat brain cells after focal cerebral ischemia reperfusion, and it can facilitate the recovery of nerve function.