To explore the observation and nursing of complications in operative patients with massive and rapid transfusion,32 cases were studied,the author summarized that the observation and nursing experience in prevention and treatment of some complications,such as overloading circulation、bleeding tendency、hypokalemia and hypothermia.

Liver fibrosis is a pathological process for the liver to repair various chronic liver injuries and may eventually progress to liver cirrhosis,liver failure,or even liver cancer.Therefore,early intervention arid treatment of liver fibrosis is of particular importance.This article summarizes the latest research advances in the roles of TGF-β/Smad signaling pathway,Notch signaling pathway,Wnt signaling pathway,Hedgehog signaling pathway,and integrin signaling pathway in the pathogenesis of liver fibrosis and points out that these signaling pathways play an extremely important role in the development and progression of liver fibrosis and may provide new directions for the treatment of liver fibrosis.

While the number of the enrolled postgraduate students is continuously increased and the various reforms go in depth, there appear some new problems and contradictions in the education of doctorial students.Among those problems,the lack of the doctorial student resource,especially the lack of the excellent doctorial student resource,is the most prominent problem that re- stricts the progress of the doctorial student education.In order to solve these problems,this article analyzes the factors influencing the resource of the students and put forward the strategy to deal with these factors.

Objective To investigate the efifcacy of interferon alpha (IFNα) followed by nucleotide analogues (NAs) treatment in patients with negative hepatitis B e antigen (HBeAg), undetectable serum HBV-DNA and low hepatitis B surface antigen (HBsAg) levels.Methods The enrolled HBeAg-negative chronic hepatitis B patients had undetectable HBV-DNA level (HBV-DNA<1000 copies/mL for at least 12 months) and low HBsAg level (HBsAg≤2000 U/mL) with long-term NAs treatment. These patients switched their therapy sequentially from NAs regimens to IFNα for 48 weeks. The treatment response was evaluated in terms of serum HBV DNA load, serological HBV markers, liver function tests and routine blood test before treatment and 12, 24 and 48 weeks of treatment. The patients were followed up for 24 weeks after treatment. The primary endpoint was HBsAg loss or seroconversion and HBsAg<10 U/mL. Logistic regression analysis was conducted to examine relevant predictive factors. Receiver operating characteristic curve was used to evaluate the value of prior HBeAg seroconversion and on-treatment HBsAg dynamics in predicting HBeAg seroconversion than in HBsAg persistence group (χ2=9.527,P=0.002). HBsAg loss was more likely in the patients who had HBsAg decline at least 0.5 log U/mL from baseline at week 12 of treatment (χ2=16.576,P<0.001). The area under the ROC curve for prediction of HBsAg loss was 0.810 (95 %CI, 0.686 to 0.935,P<0.001).Conclusions The HBeAg-negative chronic hepatitis B patients with positive virological response and low HBsAg level after NAs treatment are more likely to achieve HBsAg clearance when switched to IFNα treatment. Prior HBeAg seroconversion and on-treatment HBsAg dynamics are useful in predicting and guiding IFNα sequential therapy.

Objective To evaluate the clinical significance of a modified T-staging system for hilar cholangiocarcinoma(HCC).Methods From 1999 through 2007,98 HCC patients were stratified by the Tstaging system.Statistical differences were evaluated for resectability,radical resectability,concomitant partial hepatectomy,partial portal vein resection,histological differentiation,lymph node characteristic and survival rate.Results There were 43 HCC patients graded at T1,37 at T2 and 18 at T3 respectively.The resectability rates were 65%,40% and 11%,and radical resection was achieved in 46%,21% and 0% respectively.Resectabilities decreased with increasing T stage(χ~2=15,P<0.01;χ~2=14,P<0.01,separately).In patients with T1 and T2 tumors who underwent resection,the concomitant partial hepatectomy accounted for 60% and 73%(χ~2=0.6,P>0.05),partial portal vein resection for 3% and 33%(χ~2=4,P<0.05),poor differentiated types for 71% and 40%(χ~2=4,P<0.05),and lymph node metastasis for 50% and 40%(χ~2=0.4,P>0.05),respectively.The 1-,3-and 5-year survival rates in patients with T1 lesions were 58%,30%and 18%,in 12 patients it was 43%,11%and 0.The 1-and 2-year survival rate in T3 patients was 12%and 0.Patients witll T1 or T2 stage tumors had a significantly longer survival than those with T3(P<0.05)(Log rank χ~2=14,Breslow χ~2=12,P<0.01;Log rank χ~2=6,Breslow χ~2=4,P<0.05,individually),and the difference in survival between T1 and T2 was not significant(Log rank χ~2=2,Breslow χ~2=1,P>0.05).Conclusions The T-staging system is appropriate for preoperative evaluation in HCC patients.However,its correlation with tumor histological differentiation and lymphatic characteristics needs to be elucidated.

Objective To compare the effect of thin-sliced enhanced CT scanning and 3D-DSA data sources in the 3 D printing data reconstruction of intracranial arteriovenous malformation (AVM ). Methods Five patients with AVM were selected prospectively,3 were Spetzler-Martin grade II and 2 were grade III. Two of them used 256-slice spiral CT thin slice enhanced scanning. Three used the 3D-DSA rotating imaging,and the DICOM raw data of the examination results were extracted. Digital processing was performed by using the Mimics software,and the 3 D printing was performed according to the ratio of 1∶1 obtaining the solid model and the effects were compared. Results Using the data source 3 D printing of 256 slice spiral CT thin-slice enhanced scan could obtained skull and blood vessel image information and could reveal the smallest diameter of 0. 9 mm vessel,however,the fine branch structures of the vessel were difficult to distinguish. The 3D printing based on 3D-DSA data,although the digital subtraction did not have the skull data information,the vascular branches showed more abundant. It could reveal the smallest diameter of 0. 9 mm vessel. Conclusions Using the CT thin-slice enhanced scan or 3D-DSA data source can obtain reconstruction images of AVM nidus,and 3D-DSA shows that the better effect for spatial structure of AVM nidus. It is helpful to the design of preoperative treatment scheme and the development of corresponding auxiliary tools.

Objective To collect the families with generalized epilepsy with febrile seizures plus(GEFS+) and analyze the clinical status and heredity features of Chinese GEFS+.Voltaged-gated sodium channel ?1 subunit(SCN1B) gene of 2 families were detected,and expect to find new mutation sites.Methods All participant in the study of 2 families members were informed of voluntary participate in this investigation,health examination and blood sampling.All 6 gene exons of proband,patients and healthy control group were sequenced.The sequencing result was compared and analyzed with the normal sequence of genomic exon fragment and exon fragment sequencing result of control group through internet(BLAST).Results 1.A new G/A heterozygous polymorphism (G181A)was found in the 181th basyl of SCN1B gene exon 3,and codon was changed from TCG to TCA,both encoding serine (Ser,S).It was synonymous mutation.2.A new G/A heterozygous polymophism(G15A)was found in the 15th basyl of SCN1B gene exon 3,and codon was changed from GAG to GAA,both encoding glutamic acid(Glu,E).It belonged to synonymous mutation.3.A new T/C heterozygous polymorphism (T37C)was found in the 37th basyl of SCN1B gene exon 6.The patients genetype were:5 cases with T/C heterozygote,3 cases with T/T homozygote,2 cases with C/C homozygote.Healthy control group were all T/T homozygote.Allele frequency distribution for T was 55.0%,and 45.0% for C.4.A new A/C heterozygous polymorphism (A81C)was found in the 81th basyl of SCN1B gene exon 6.The patients genetype were:5 cases with A/C heterozygote,3 cases with A/A homozygote,2 cases with C/C homozygote.Healthy control group were all A/A homozygote.Allele frequency distribution for A was 55.0%,and 45.0% for C.Conclusions Two new heterozygous polymorphism (G181A),(G15A) were found in SCN1B gene exon 3.Two new heterozygous polymorphism (T37C),(A81C) were found in SCN1B gene exon 6.These 4 polymorphism enriched single nucleotide polymorphism(SPN) database and provided candidate sites for the research of epilepsy susceptbility polymorphisms.

Generalized epilepsy with febrile seizures plus(GEFS+) is a new epilepsy syndrome proposed by International League Against Epilepsy.At present,the progress of genetic studies of GEFS+ focus on gene mapping based on family analysis,many researches indicate that GEFS+ is associated with voltaged-gated sodium channel(SCN) gene mutation.This paper intends to discuss the relationship beween GEFS+ and SCN1B,SCN2B,SCN1A,SCN2A genes,mutations in order to improve the cognition about GEFS+.

BACKGROUND:Bone marrow mesenchymal stem cel s have been shown to be differentiated into periodontal ligament fibroblasts when co-cultured with periodontal ligament cel s. Existing studies have shown that estrogen has the ability to influence bone marrow regeneration. OBJECTIVE:To investigate the effects of estrogen on osteogenesis and fibroblast-related factors alkaline phosphatase, type I and III col agen in bone marrow mesenchymal stem cel s. METHODS:Bone marrow mesenchymal stem cel s isolated from Beagle dogs were treated with estrogen. Osteogenesis and fibroblast-related mRNA and protein expression of bone marrow mesenchymal stem cel s was determined by RT-PCR and western blot assay, respectively. RESULTS AND CONCLUSION:mRNA and protein expression of type I and III col agen in bone marrow mesenchymal stem cel s was upregulated fol owing estrogen treatment;especial y, in contrast with type III col agen, the changes of type I col agen were more obvious. Estrogen did not influence mRNA and protein expression of alkaline phosphatase. These findings suggest that estrogen promotes the differentiation of bone marrow mesenchymal stem cel s into fibroblasts, whereas does not impact the genes involved in parodontium mineralization.