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.

BACKGROUND: Quiet a number of researches has reported the morphological changes of global ischemic reperfusion model. However, there are few reports on the ultrastructural changes of cortex in early reperfusion, especially the change of blood brain barrier.OBJECTIVE: To explore the changes of brain cortex neurons, glial cells and blood brain barrier in order to provide reliable evidence for clinical treatment.DESIGN: A randomized and controlled trial.SETTING: Department of Neurosurgery, Departnent of Anesthesia and Electron Microscope Room of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted to 6 Wistar rats in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during February 2003 to February 2004. The rats were randomly divided into two groups with one of ischemia-reperfusion group and sham operation group with 3 rats in each group.INTERVENTIONS: To prepare global ischemic reperfusion model of rats. Brain was removed from ischemic group in one hour of reperfusion and from sham operation group one hour after the operation. Electronic microscope technique was used to observe the ultrastructural changes of cortex.MAIN OUTCOME MEASURES: Ultrastructural changes of cortex.RESULTS: The neurons of cortex shrank to certain degree in the early stage of ischemic reperfusion(1 hour) . The glial cells were swollen with dissolved chromosome in nucleus and unclear nuclear membrane. The foot protrusions around blood vessel slightly swelled and separated from basement membrane. Mircro-tubes were partially dissolved.CONCLUSION: In early stage of reperfusion injury, the cortex neurons, glial cells, cellular framework and blood brain barrier already changed which suggested that the protective treatment such as reducing brain edema, protecting blood brain barrier should start as early as possible.

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.

End Stage Liver Disease ; Humans ; Prognosis ; ROC Curve ; Retrospective Studies ; Risk Factors

As a new service form,community medical service provides primary health care for residents and it is operated with reasonable medical expenses.The function and service range of community medical service have reached consensus in medical industry,but the key issues of how to gain the market by competitive products and reasonable price have not been solved.This article analyzes the position of community medical service in healthcare system to clarify its unique attributes.The article further discusses the contents and pricing characteristics of community medical service,and the main influencing factors.The article introduces the issues dealing with community medical service product development,including the procedure of development,key points at different stages of development and the related research methods for the development of new service products.

Objective To investigate the effects of essential fatty acids(EFA)on the contents of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the brain tissues of rats. Methods A total of 30 neonatal rats, 1 month old, were randomly divided into normal, EFA deficiency and fish oil supplement groups and given different feeding stuff for 3 months respectively. The contents of EPA and DHA in brain tissues were determined by high performance liquid chromatography (HPLC). Results As compared with normal group, the contents of EPA and DHA in EFA deficient group were significantly decreased(P

OBJECTIVETo analyze and summarize the characteristics and treatment of acute spinal cord decompression sickness. To explore the factors that influence the treatment effect.

METHODS77 cases of acute spinal cord decompression sickness patients should be divided into 4 groups according to the pressurized treatment and drug treatment options. They were group I, group II, group III and group IV. At the same time they were get hyperbaric oxygen therapy and other treatment. The evaluation index, were Frankel function classification and paraplegia index. There were 17 factors that affected the treatment effect.

RESULTSThe rate of early cure was 57.14% (44/77). The rate of late cure was 74.03% (57/77). Their difference was statistically significant (P<0.05). In 3 months and 1 year the cure rate of group IV and group B were the highest. But there was no difference between them(P>0.05). They were higher than group ii and group I (P<0.05). The Frankel function classification in 3months and 1 year in each group was higher than before treatment (P<0.05). The paraplegia index in 3 months and 1 year in each group was lower than before treatment (P<0.05). In 3 months and 1 year the Frankel function classification was increased gradually and the paraplegia index was decreased gradually in group I , group II, group III (P<0.05). In group IV and group III the Frankel function and the paraplegia index had not significant difference (P>0.05). Among the 17 factors that affect the treatment effect there are 9 factors that affect the proportion of the large.

CONCLUSIONSThe first choice of treatment method for the patients with acute spinal cord decompression sickness would be group III. Drug therapy was also imporpant. At the same time the hyperbaric oxygen therapy and other treatments were taken. Although the cure rate was not high in this article. But most of the cure is within 3 months. Within 1 year.the cure rate still could be improved. 9 factors that affect the efficacy of acute spinal cord decompression sickness was more noteworthy.

Decompression Sickness ; therapy ; Diving ; adverse effects ; Humans ; Hyperbaric Oxygenation ; Paraplegia ; physiopathology ; therapy ; Spinal Cord ; physiopathology

This article introduces the clinical requests of indigenous diagnostic imaging ultrasound devices in first-time registration application and the clinical trial requests in Technical Review Guidance of Ultrasound Imaging Diagnostic Devices (category III) Registration and puts forward some questions of the guidance's implementation. It is hoped to help concerned people.
China ; Clinical Trials as Topic ; standards ; Device Approval ; legislation & jurisprudence ; standards ; Guidelines as Topic ; Ultrasonography ; instrumentation

OBJECTIVE:To discuss the way to realizing clinical pharmacists’prescribing rights,and to provide reference for the revise of related policies and regulations. METHODS:The clinical pharmacists prescribing rights and its necessity were inter-preted. Referring to pharmacists’prescribing rights in Canadian limited prescription mode,British dispensatory mode,United States consultative prescription mode,clinical pharmacists’prescribing rights in China were expounded. RESULTS & CONCLU-SIONS:It is necessary and feasible to achieve clinical pharmacists’prescribing rights in China. Clinical pharmacists’prescribing rights can be realized and the pharmaceutical role of clinical pharmacists can be played through conducting clinical pharmacist pre-scription training,establishing chronic disease,common disease,mild disease and other disease dispensatory,gradually revising the concept of“prescription”and“prescribing rights”,promoting the legislation of pharmacists and clinical pharmacists’prescrib-ing rights,promoting the realization of the prescription right of clinical pharmacist,prompting clinical pharmacist to play the role of pharmacy.

Objective To investigate the difference of endothelial cell (EC) in ultrastructure,markers and permeability between blood-brain barrier (BBB) and blood-nerve barrier (BNB).MethodsThe rat brain cortex and sciatic nerve were removed.Ultrastructure of endothelial cell was observed with electron microscopy.Employing immunohistochemical (IHC)staining,the relative distribution was determined for the OX-26,endothelial barrier antigen (EBA)and extravasated fibrinogen around microvessels.ResultsMicrovessels both in BBB and in BNB did share the same tight junctions.However,BNB had a significantly larger number of vesicles than that of BBB.Microvessels in BNB did not express the OX-26 and EBA,but staining weakly positive for fibrinogen,while microvessels in BBB showed strong positive for OX-26 and EBA,perivascular staining of fibrinogen had not been seen.ConclusionTight junctions were present in both BBB and BNB endothelial cell,but there was a significant difference between them in the number of the pinocytotic vesicles,markers expression and permeability.

Objective To observe the effect of sensory stimulation on swallowing functional recovery in patients with cerebrovascular disease .Methods 60 cerebrovascular accident patients with swallowing dysfunction were randomly divided into research group ( 30 cases ) and control group ( 30 cases ) .The control group was given conventional swallowing function training ,the research group was given sensory stimulation training on this basis of the control group .Before treatment and 1 month after treatment , kubota drinking water test and feeding -swallowing function rating were used to evaluate the swallowing ability of the two groups .Results There were no statistically significant differences between the two groups in terms of sex ,age and course of disease (all P >0.05).Before treatment,the ability of swallowing between the two groups had no statistically significant difference [( 3.27 ± 1.14)points vs.(2.97 ±1.43)points,t=0.646,P>0.05].After 1 month of treatment,the swallowing ability score of the two groups[(7.10 ±1.16)points vs.(5.07 ±1.55)points;t=8.046,P<0.01]and swallowing function grade (90.0％vs.63.3％,χ2 =7.638,P<0.05) were significantly higher than those before treatment .which of the study group were more significant , and the differences between the two groups were statistically significant .Conclusion Various sensory stimulation for patients with dyspraxia after cerebrovascular accident is obviously better than monotherapy ,which can effectively improve the swallowing function of patients with cerebrovascular disease .