Objective: To evaluate the value of MELD-Na scoring system, MELD scoring system and Child-Pugh scoring system for liver failure with artificial liver support. Methods: The values of MELD-Na scoring system, MELD scoring system and Child-Pngh scoring system were evaluated using receiver operating characteristic (ROC) curves. Results: The area under curve (AUC) values generated by the ROC curves for Child-Pugh score were higher (AUC=0.794) than those of ME LD-Na score (AUC=0.724) and MELD score (AUC=0.664) respectively. The eutoff scores of three systems were 10.5, 24.8, 26.4 respectively, which could discriminate higher and lower mortality accurately. There were no significant statistic differences in predictive values of three systems for different liver failure(sub-acute liver failure and chronic-on-acute liver failure). But the Child-Pugh scoring system was the best for prediction of the chronic liver failure. Conclusion: MELD-Na scoring system,Child-Pugh scoring system and MELD scoring system can predict the prognosis of liver failure, in which the Child-Pugh scoring system was the best.

Early screening and intervention on post-stroke dysphagia (PSD) is very important in stroke treatment. Rehabilitation training and acupuncture are the main therapies on PSD. Comprehensive and individualized treatment under multi-disciplinary management models is the future direction. Normalizing clinical manipulation and constructing reasonable efficacy evaluation system are the key problems to be solved.

Objective To observe the changes of behavior, intracellular free calcium and the expression of calmodulin dependent protein kinase Ⅱ(CaMKⅡ) in the hippocampal neurons of chronic forced swimming stress rats. Methods Male Wistar rats were randomly divided into control group and chronic forced swimming stress group. The behavior was examined using sucrose preference test, open-filed test and Morris water maze. The intracellular free calcium was examined by fluorescence spectrophotometer. The expression of CaMKⅡ was detected using colloidal gold immunoelectron microscopy technique, Western blotting and RT-PCR. Results The consumption of sucrose and erect quantity of chronic forced swimming stress group were lower than those of control group(P<0.01, P<0.05). The escape latency time in Morries water maze test of chronic forced swimming stress group was higher than that of control group(P<0.01). The intracellular free calcium level and the expression of CaMKⅡ in the hippocampus was higher than that of control group(P<0.01).Conclusion The lasting dysfunction of Ca~(2+)/CaMKⅡ signaling cascades in hippocampus may play important roles in the pathogenesis of chronic forced swimming stress rats.

Objective To introduce a modified replantation for thumb rotating avulsion amputation,and to evaluate its short term clinical outcome.Methods From January 2007 to July 2009,7 patients with thumb rotating avulsion amputation underwent replantation,including 6 males and 1 female,aged from 21 to 47 years (average,28.3 years).The amputation level of each thumb was metacarpophalangeal joint.During operation,fusion of metacarpophalangeal joint was performed according to injury degree of soft tissue; interphalangeal joint of the thumb was fixed in 15 degrees of flexion by sewing flexor pollicis longus muscle tendon and extensor pollicis longus muscle tendon to tendon sheath or soft tissue; the superficial vein harvested from ipsilateral forearm was used to bridge the dorsal carpal branch of radial artery and the ulnar palmacollateral artery of the thumb; direct anastomoses of dorsal veins were performed in 6 cases and venous transplantation in 1 case; and bilateral nerves were transferred to the back of the first metacarpal and anastomosed to the superficial branch of the radial nerve.Results All 7 replanted thumbs survived completely.Arterial crisis occurred in 1 case after operation,which was cured after operative and medication treatment.The follow-up period ranged from 3 to 24 months.The appearance and opposition function of replanted thumbs were satisfactory and the sensation of fingertip recovered to S4 in 4 cases and to S3 in 3 cases.The two point discrimination ranged from 8 to 12 mm.Conclusion Because bridging the dorsal carpal branch of radial artery and the ulnar palmar collateral artery of the thumb with a superficial vein harvested from ipsilateral forearm to reconstruct blood supply of the thumb is available and easy to be performed,this modified replantation is an ideal way to repair thumb rotating avulsion amputation.

AIMTo investigate the effect of morp hine on purine nucleotides catabolism and its possible mechanisms. METHO DSRats were administered with morphine by intraperitoneal injection with increasing dose to develop ad diction model. The determination of uric acid concentration in plasma and the ac tivities of xanthine oxidase (XO) in the plasma and the small intestine were per formed. RT-PCR was used to examine the expressing level of key enzyme of purine nucleotides catabolism,XO mRNA. ?-actin was used as control gene in RT-PCR s tudy. RESULTSThe concentration of uric acid in plasma was sign ificantly increased in morphine-pretreated rats compared with control(P

Chinese herbal medicine (CHM) has been widely used in the treatment of multiple sclerosis (MS). However, there is no systematic review to assess the efficacy and safety of CHM.

Background Rhodopsin (RHO) gene is the most common disease gene for autosomal dominant retinitis pigmentosa (adRP),one of the main pathogenesis is that misfolded mutant RHO proteins accumulate in the endoplasmic reticulum and cause endoplasmic reticulum stress (ERS).Objective This study aimed to determine the genetic basis for a consanguineous Chinese Han adRP family.Methods This study procedure complied with Helsinki Declaration.All participants in the family were investigated under the informed consent.Regular ocular examination was performed on the patients in this family.Next-generation sequencing (NGS) was carried out to screen the mutations in 189 genes associated with hereditary retinal diseases (HRDs).After being analyzed and filtered,variations detected by NGS were validated by Sanger sequencing and evaluating of pathogenicity.The wild-type RHOWT and mutant RHOP53Rwere cloned into the vector pEGFP-N1.Then the two plasmids were transfected into adult retinal pigmentosa epithelium cell line(ARPE19) and human embryo kidney 293 line (HEK293) to observe the location of rhodopsin-GFP fusion protein in cells,and the expression of ERS related protein XBP1 in the cells was detected by quantitative-PCR and Western blot.Results This family included 5 generations with the typical adRP characteristics.Genetic analysis identified a heterozygous variation,p.P53R in RHO gene,which was fully cosegregated in the family.Wild-type RHOWT-GFP fusion proteins showed the green fluorescence on the endoplasmic reticulum and cytomembrane,but the misfolded mutant RHO-GFP fusion protein gathered only in endoplasmic reticulum.Compared to wild-type RHOWT,the XBP1 was activated and increased by (1.28 ±0.09) fold.The introns of 26 bases in XBP1 mRNA were removed in the HEK293 cells with mutant RHO-GFP fusion protein,and the expression of XBP1 was stronger in the HEK293 cells with mutant RHO-GFP than that in HEK293 cells with wild type RHO-GFP and cells with blank pEGFP-N1 plasmid.Conclusions Heterozygous variant RHO p.P53R is very likely the pathogenical mutation in the adRP family.The RHOP53R mutant rhodopsin protein can not be delivery effectively from the endoplasmic reticulum to the cell membrane,and these proteins accumulate in the endoplasmic reticulum,which causes ERS.

Objective To investigate the feasibility of reducing spine metal artifacts with metal artifacts reduction technique (WARP) at 3.0 T MRI.Methods This study included 15 cervical and 14 lumbar spine cases.The image quality of WARP sequences and conventional sequences were compared (5 score evaluation scale) as well as the signal to noise ratio (SNR) and contrast noise ratio (CNR) of the image artifacts.The scanning time was recorded.Paired-t test and Mann-Whitney test were used respectively to compare the SNR and CNR,and qualitative scoring between the two sequences.P＜0.05 was considered to indicate a significant difference.Results The image distortion and blur of the WARP sequences were obviously reduced as compared to the conventional sequences.The SNR and CNR of artifacts of the WARP sequences were lower than that of the conventional sequences (All P＜0.05).The image quality scores of WARP sequences in cervical and lumbar spines[4(3 to 5) and 4(3 to 5)] were higher than that of conventional sequences[3(2 to 4),3(2 to 4)](P＜0.05).The scanning time of cervical spines in WARP sequence(14 min 9 s) was increased by 64 s (8.2％),and the time of lumbar spines (13 min 41 s) decreased by 9 s (1.1％).Conclusion The WARP sequences at 3.0 T could effectively reduce the artifacts of metallic prosthesis in cervical and lumbar spine without prolonging the scanning time at 3.0 T MRI.

OBJECTIVETo identify independent risk factors influencing the survival time of patients with chronic liver failure and construct a predictive model.

METHODSRetrospective analysis was applied to clinical data of 362 patients with chronic liver failure treated with artificial liver in Tianjin third centre hospital between May 2002 and May 2007. Data were analyzed with SPSS 13.0 statistic software, t test and rank test were used on quantitative data, chi-square test was used on qualitative data, Cox regression analysis was used to select the independent risk factors influencing the survival time. According to independent risk factors from Cox regression model, a prognostic model was established.

RESULTS1. Independent risk factors (P less than 0.05) influencing the survival time were: Child-Pugh score, bilirubin separation ALT, ascites, arginine, age, tyrosine and serum sodium. 2. By receiver operating characteristic curves (ROC) analysis, the area under ROC (AUR) to predict the outcome of chronic liver failure patients was 0.782, and the cutoff score was 27.69.

CONCLUSIONS1. Child-Pugh score, bilirubin separation ALT, ascites, arginine, age, tyrosine and serum sodium are independent risk factors affecting survival time of patients with chronic liver failure. 2. Cox model we constructed can reliably predict the survival time of patients with chronic liver failure.

Objective To compare and analyze the phylogenetic tree and sequence variant characteristics of Klebsiella species between 16S rDNA and rpoB. Methods Eighteen isolates identified as genus Klebsiella (with 15 of K. Pneumoniae and 3 of K. Oxytoca) by automated biochemical tests were selected. DNA were extracted, 16S rDNA and rpoB genes were amplified and sequenced with Klebsiella 16S rDNA and rpoB primers. Together with already published 8 species of Klebsiella and 9 species of Enterobacteriaceae 16S rDNA and rpoB sequences from GenBank, totally 35 sequences of 16S rDNA and rpoB respectively, phylogenetic trees were constructed with MEGA 4.0 to the analysis of groups. DNAStar/MegAlign was used for comparison of variable regions of 16S rDNA and rpoB, with analysis of degree of divergent at the same time. Results As for all 35 sequences, both 16S rDNA and rpoB phylogenetic trees divided Klebsiella species into three groups, 15 of K. Pneumoniae in this study and 6 of K. Pneumoniae from GenBank (except for K. Oxytoca and K. Mobilis) cluster to group Ⅰ, K. Oxytoca and K. Mobilis were cluster to group Ⅱ and Ⅲ, respectively. In rpoB phylogenetic tree, no matter group Ⅰ and group Ⅱ, or subgroup within group Ⅰ, the bootstrap values in each node of rpoB phylogenetic tree is obviously higher than that of 16S rDNA. Moreover, as for cluster to K. Oxytoca, rpoB is better than 16S rDNA. Analysis nucleic acid sequences of Klebsiella species, with 41 variable regions and 4 most significant regions were found within the Klebsiella 16S rDNA, while rpoB with 63 variable regions, and 1 most significant region. The similarity of 16S rDNA and rpoB within Klebsiella were 95.9%-100% and 90.2%-100% respectively. Further analysis divergent degree of 16S rDNA and rpoB within Klebsiella, the divergent value of rpoB (0-10.6) is higher than that of the 16S rDNA(0-4.0). Conclusion As for molecular classification and identification within KlebsieUa species, rpoB has more advantages than 16S rDNA.