Objective To investigate the risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) .Methods 181 cases of patients after TIPS diagnosed in this department from January 2009 to December 2013 were reviewed .The patients were divided into two groups:42 cases with hepatic encephalopathy (HE group)and 139 cases without he-patic encephalopathy(control group) .To evaluate the possible risk factors such as age ,sex ,pathogeny of cirrhosis ,complications [(Child-Pugh score ,portal pressure gradient (PPG ) ,Child-Pugh grading ,fibrinogen ,hemoglobin ,serum natrium ] were recorded and analyzed .Unconditional logistic regression model(W ald test)was used to screen the independent risk factors .Receiver operating characteristic curve was plotted and the area under it was calculated to evaluate the diagnose performance .Results There was no significant statistical difference between HE group and control group about age ,sex and pathogeny of cirrhosis(P>0 .05) .Analysis of unconditional logistic regression model indicated that Child-Pugh score ,PPG ,Child-Pugh grading ,were single risk factors of HE after operation(OR=1 .29 ,1 .06 ,1 .22) ,while fibrinogen ,hemoglobin and serum natrium were protective factors .ROC curve was plotted and the AUC was calculated to evaluate the diagnose performance ,which indicated the sequence was that ,Child-Pugh score> PPG>Child-Pugh grading>hemoglobin>fibrinogen>serum natrium .Conclusion Child-Pugh score ,PPG ,Child-Pugh grading , fibrinogen ,hemoglobin and serum natrium were single hazard factors of HE after operation .

Objective To compare diffenrent amounts of the glycyrrhizic acid extracted by two methods-decoct method and Ammonia-water method.Methods The best extraction conditions including amount of affusion water and solvent,extraction time,boiling time,crash time,vibrating time and concentration of ammonia were choosed by orthogonal design.Amounts of the glycyrrhizic acid were determined by ultraviolet spectrophotometry at 252 nm wavelengh.Result The best extraction conditions from decoct method were that amount of affusion wate was 200 mL,extract 2 times,boiling time was 5 min,crash time was 20 s.The best extraction conditions from Ammonia-water method were that amount of 0.4% ammonia was 200 mL,vibrating time was 2 h,extract 2 times.The extraction rate of Ammonia-water method was 32%,and the extraction rate of decoct method was 26%.Conclusion For glycyrrhizic acid extraction and purity,Ammonia-water has superior efficient than decoct method at the best conditions.

Objepctive To explore the protective effect of modified recombinant human aFGF ( Mrh-aFGF) on the neurons in ventral tegmental area of rats with Parkinson’ s disease ( PD) . Methods The 54 SD rats were ramdomly divided into the control group,the model group and the treatment group,and there were 18 rats in each group. PD rats of the model group and the treatment group were induced by in-jecting 6-OHDA into the left substantia nigra compacta ( SNC) and ventral tegmental area ( VTA) to build the PD model. Rats in the treat-ment group were given Mrh-aFGF injection after lateral ventricle injection,and the behavioral changes of the rats were detected after apomor-phine injection. The morphologic features and pathological changes of neurons in the ventral tegmental area were observed by Nissl’ s staining and electronic microscope. Results Compared to the right VTA of PD rats,the number of neurons in left side ( the injured side) decreased significantly in the model group(P<0. 05). In the treatment group,the structure of left (the injured side) VTA was markedly improved and the number of neurons was increased one week,two weeks and four weeks after operation compared with the model group (P<0. 05). The neurons in the VTA of the model group were found to have karyopyknosis,endoplasmic reticulum,degranulation,mitochondria swelling,cristae disappear,pre-synaptic and post-synaptic membranes swelling,and synaptic cleft disappear. In the treatment group,the ultrastructure of the neurons in the VTA,such as nuclei,mitochondria,synaptic structure,kept well compared to the model group. Conclusion Mrh-aFGF could protect the neurons in the ventral tegmental area from the loss and improve the ultrastructure of the neurons of PD rats.

Objecfive To explore the value of endoscopic uhrasonography(EUS)in diagnosis and preoperative assessment of esophageal cancer.Methods A total of 57 patients with esophageal cancer were examined by EUS.The image features,depth of invasion and lymph node metastasis obtained by EUS were analyzed and compared with postoperative outcomes.Results Esophageal cancer was characterized as an irregular hypoeehoic mass with partial or total destruction of normal esophageal wall structure under EUS.Compared with post-operative pathological findings,the consistent rates of EUS diagnosis in depth of invasion,T staging,and N staging were 84.2%(48/57),87.7%(50/57)and 84.2%(48/57),respectively.Conclusion EUS exhibited high diagnostic accuracy in T staging of esophageal cancer,which is valuable in managements and prognosis of esophageal cancer.

Objective To determine the correlation between Smad4 mRNA,protein expression,abnormal methylation of CpG islands of Smad4 and colorectal cancer.Methods The expression of Smad4 in 43 cases of colorectal cancer and its adjacent tissue.30 cases of colorectal adenoma and 12 normal colon mucosa were analyzed by RT-PCR,sequencing,semi-quantitative RT-PCR,methylation-specific PCR(MSP)and immunohistochemistry.Results The mRNA expression of Smad4 was detected in 25 cases of colorectal cancer(58.14%),with expression levels at 0.73±0.25,which was significantly lower than those in corresponding adjacent tissues(88.37%,0.95±0.29),eolorectal adenoma(90.63%,1.01±0.37)and normal mucosa(100.00%,1.18 ±0.33)(P＜0.05).The positive rates of Smad4 gone promoter methylation in colorectal caner(60.53%)was significantly higher than that in other tissues(27.03%,25.00%and 16.67%,respectively,P＜0.05).The expression of Smad4 protein was significantly lower in colorectal cancer(44.19%)than that in other tissues(81.40%,87.50%,91.67%,respectively,P＜0.05),which was correlated with tumor invasion and lymph node metastasis.Conclusion Down-regulation of Smad4 expression may be associated with the development,the biological behavior and prognosis of colorectal cancer,and it can be an important biological marker in evaluation of disease progression.

BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE:To investigate the efficacy of intra-articular injection of tranexamic acid on postoperative blood loss and limb circumference changes in patients who received unilateral total knee arthroplasty. METHODS:From March to October 2013, clinical data of 90 patients undergoing primary unilateral total knee arthroplasty were randomized to the tranexamic acid group and the control group, including 19 males and 71 females. The 30 patients in the tranexamic acid group received 50 mL of 3%tranexamic acid dilute solution inside knee joint after capsule closure, and 60 patients in the control group received the same volume of physiological saline. No significant difference in age, height, body mass index, anticoagulation, the type of prosthesis, tourniquet time and preoperative diagnosis was detected between the two groups (P>0.05). The amounts of intraoperative and postoperative blood loss and blood transfusion, postoperative drainage volume, the preoperative and postoperative limb circumference 10 cm above the operated knee were recorded. Routine blood test was reviewed after the surgery. RESULTS AND CONCLUSION:There were no significant differences in total blood loss, postoperative drainage volume and limb circumference changes between tranexamic acid and control groups (P>0.05). The amount of postoperative hidden blood loss was significantly less in the tranexamic acid group than in the control group (t=-2.683, P<0.05). These data suggested that the intra-articular injection of tranexamic acid intraoperatively in patients receiving total knee arthroplasty could significantly reduce the amounts of postoperative hidden blood loss, and did not affect the postoperative limb circumference changes.

BACKGROUND:As a more common method in the orthopedic field, the method of intra-articular injection drugs has distinct curative effects, but there are some complications. In a certain extent, this method caters to the psychological fear of surgery, and can serve as a kind of conservative treatment. But some experts believed that because of the limit of sterile conditions, intra-articular injection of drugs wil increase the risk of intra-articular infection and they opposed this method.
OBJECTIVE:To review the efficacy and adverse reactions of intra-articular injection drugs in recent years, and explain clinical applications of intra-articular injection drugs in orthopedics.
METHODS:A computer-based search was conducted in PubMed and Wanfang database for articles related to the application of intra-articular injection drugs in orthopedics published between January 2007 and December 2013. The English and Chinese key words were“intra-articular, injection, orthopaedics, tranexamic acid, hyaluronic acid, corticosteroid, drugs”. Data were checked in the first trial, old articles and repetitive studies were excluded. The relevant 43 articles accorded with inclusion criteria were reviewed.
RESULTS AND CONCLUSION:In orthopedics, the method of intra-articular injection drugs is simple, economic and effective, but at the same time, there are some side effects. Tranexamic acid by intra-articular injection can significantly reduce blood loss after total joint replacement, is safety and economic. Intra-articular injection joint lubricant can reduce internal friction of joints and improve the adhesion of joint cavity, can be used as a good conservative treatment for osteoarthritis. Intra-articular injection hormone drugs can treat inflammatory arthritis, and short-term curative effect is obvious, but due to large long-term side effects, the method is not recommended now. Intra-articular injection of analgesic drugs and other drugs have both advantages complications. The efficacy of intra-articular injection drugs in orthopedics is obvious;meanwhile, this method has some complications. Orthopedic surgeons should select related drugs by indications. We stil need to further make reasonable regimen with intra-articular injection drugs in future large-scale study.

Objective To analyse the significance of proto oncogene protein in oral squamous cell carcinoma and oral leukoplakia.Methods 40 patients who were diagnosed with oral leukoplakia (OLK),40 patients who were diagnosed with oral squamous cell carcinoma(OSCC),and at the same time, 40 healthy volunteers as control group were collected.the lesions and normal oral mucosa were taken as samples, left supernatant after grinding, MDM2 protein, p53 protein and Ki-67 protein were detected by ELISA in three groups,and analyse the correlation between three groups.Results Among three groups,MDM2, p53 expression:OSCC group>OLK group>control group (P<0.05).Ki-67 expression level among three groups, OSCC group>OLK group>control group (P<0.05).MDM2, p53, Ki-67 expression had a positive correlation in OSCC group and OLK group (P<0.05), but there was no obvious correlation in control group.Conclusion When oral leukoplakia developes into oral squamous cell carcinoma, MDM2, p53, Ki-67 shows high expression, and there is a positive correlation between MDM2, p53, Ki-67.

Objective To explore the knowledge about HIV/AIDS and related factors associated among farmer workers with private corporations in Guangxi and to inform intervention programs.Methods Questionnaire survey was conducted among workers working with 10 private corporations,and data were analyzed using logistic regression.Results Correct answers to questions about HIV/AIDS transmission route accounted for over 85%,yet much less regarding knowledge about non-transmission routes and prevention methods.The factors associated with knowledge about HIV/AIDS included gender,age,nationality,registered living place and years of schooling.Conclusions HIV/AIDS-related education should be strengthened for farmer workers working for private corporations.

Objective To investigate the clinical value of continuity nursing model in caring patients with malignant obstructive jaundice treated with percutaneous transhepatic biliary drainage (PTBD).Methods A total of 120 patients with malignant obstructive jaundice treated by PTCD were enrolled in this study.The patients were divided into the control group (n=60) and the observation group (n=60).Routine discharge guidance and health education was conducted for the patients of control group,while for the patients of observation group,in addition to conventional discharge education,the continuity nursing was executed by the responsible nurse.Continuity nursing was meant to continue the service,to guide the observation of the wound and dressing change,the observation of the quantity and quality of drainage solution,to teach the knowledge of the management of PTCD catheter as well as its complications,to guide patient's diet and rest,and to establish the continuity nursing records.Results The patients of both groups were followed up for 3 months.The patients' awareness rate of the knowledge related to PTCD tube in the observation group was significantly higher than that in the control group.The wound infection rate,the rate of PTCD tube prolapse or blockage,and the tube-related re-hospitalization rate in the observation group were strikingly lower than those in the control group (P＜0.05).Conclusion The continuity nursing model can significantly improve patients' awareness rate about the knowledge related to PTCD tube,reduce the incidences of biliary tract infection,PTCD tube prolapse or blockage,wound infection,and tube-related re-hospitalization,therefore,the quality of life can be surely improved.