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.

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.

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 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.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hepatitis B, Chronic ; complications ; drug therapy ; Humans ; Liver Cirrhosis ; drug therapy ; etiology ; Male ; Middle Aged ; Phytotherapy ; Tablets

BACKGROUND: There are many drawbacks with hormone replacement therapy for menopausal syndrome. The blood levels of 5-HT and norepinephrine are lower. Fluoxetine hydrochlorde(ProzacR) is a selective serotonin reuptake inhibitor which is widely used in treating anxiety and depression,OBJECTIVE: To evaluate the effect of combined antidepressant and estrogen therapy compared to estrogen alone in the treatment of perimenopausal syndrome in this prospective open study.DESIGN: Randomized comparative study.SETTING: Department of Obstetrics and Gynecology of the First Affiliated Hospital of Chongqing Medical University PARTICIPANTS: From November 2003 to December 2004, 60 female patients with diagnosed menopausal syndrome of 3-12 month duration, aged (46±3) years, from Department of Obstetrics and Gynecology of the First Affiliated Hospital of Chongqing Medical University were enrolled into the study after giving their informed consents. The patients were randomly divided into two equal groups with Group 1 (n=30) receiving a combination of antidepressant + estrogen and Group 2 (n=30) receiving estrogen only.METHODS: Patients in Grgup 1 received fluoxetine hydrochloride (ProzacR) 20 mg orally every morning plus oral estradiol 1 mg once every two weeks for 2 months. Patients in Group 2 received only oral estradiol 1 mg once every two weeks for two months. Patients were not taking any other drug during the treatment period. At the end of two month treatment all patients were evaluated with the following 3 assessment tools: ①female menopausal symptom evaluation with the following 4 categories: Complete symptom relief, markedly improved, improved and no effect. Overall efficacy was defined as 50% symptom improvement. ② Hamilton Depression Scale which reflects energy level and psychosomatic factor of sleep and anxiety. ③Menopause index: Which are description of clinical evaluation and adverse effects; this would help to assess the safety of using both drugs in treating the menopausal syndrome.MAIN OUTCOME MEASURES: female menopausal symptom assessment, hamilton depression scale, and menopause index.RESULTS: ① In female menopausal symptom assessment group 1 showed better results in the complete relief and markedly improved scores. ②Hamilton Depression Scale group 1 also showed better scores than Group2(In Groupl, the scores at week 1 to 8 were 25,18,15,10,8,5,5,4 respectively ,in Group 2, the scores at week 1 to 8 were 25,17,15,14,13,12,13,13 respectively). ③ Group 3 showed a significant better score in the menopausal index with improvement in sleep disorder, anxiety and depression than Group 2 (In Group 1 the scores at week 1-8 were 32,22.5,15,15,14,15,15,14 respectively,In group 2, the scores at week 1 to 8were 33,21,16,14,13,12,13,13 respectively) ,there was no significant difference of incidence of adverse events as compared with Group 3 .CONCLUSION: Combined therapy of fluoxetire hydrochlarde(PROZAC)plus estrogen showed better efficacy in the treatment of menopausal syndrome than estrogen alone.

BACKGROUND: Antinuclear antibody, anticentromere antibody, anti-cytoplasm antibody, and antibody against SCL-70 are the main self-antibodies involved in systemic scleroderma (SSc) and are closely connected with the development of SSc.OBJECTIVE: To probe the value of various self-antibodies and proteins in evaluating the functional prognosis of patients with SSc. DESIGN: Case-control study.SETTING: Clinical Laboratory of Second Hospital Affiliated to Jiangxi Medical College.PARTICIPANTS: Totally 74 patients, 19 males and 55 females aged 12-59years old, were confirmed of SSc at the outpatient and inpatient departments of Second Hospital Affiliated to Jiangxi Medical College between December 1995 and December 2004. There were 46 cases of diffuse cutaneous SSc, 24 cases of localized cutaneous SSc, and 4 cases of overlapping syndrome. Meanwhile40 inpatients (14 males and 26 females aged 19-54years old) who received treatment due to other diseases were recruited from the same hospital.METHODS: The level of antinuclear antibody, anticentromere antibody,and anti-cytoplasm antibody was detected with indirect irnmuneofluorescence assay; antibody against SCL-70 was detected with Western blot; the level of serum immunoglobulin, C-reactive protein (CRP) and rheumatoid factor was examined with velocity dispersion turbidimetry.ticentromere antibody, anti-cytoplasm antibody, and antibody against SCL-70;RESULTS: Blood samples collected from the 74 patients with SSc and 40controls were proved eligible and all data entered the final statistical analanti-cytoplasm antibody, and antibody against SCL-70: It was obviously higher in SSc group than in control group [66% (49/74), 53% (39/74), 39%(29/74), 7% (5/74), 0, (x2=57.15, P ＜ 0.01)]. The positive rate of antinuclear antibody in patients with diffuse cutaneous SSc was significantly lower than in patients with localized cutaneous SSc [57% (26/46), 83%(20/24),(x2=5.03, P ＜ 0.05)], but the positive rate of antibody against SCL70 was significantly higher than localized cutaneous SSc [48% (22/46),rheumatoid factor in patients with SSc was markedly higher thanin control group [(16.89±11.94), (11.89±2.05) g/L; (23.06±6.18), (22.44±5.53) IU/mL,t=8.01, 2.46, P ＜ 0.01].CONCLUSION: The positive rate of antinuclear antibody, anticentromere antibody, anti-cytoplasm antibody, and antibody against SCL-70, as well as the level of immunoglobulin G and rheumatoid factor were obviously increased in patients with SSc, suggesting that these experimental parameters have the value in evaluating the prognosis of SSc.

Objective To explore antibiotics resistance profiles and DNA fingerprints of Pseudomonas aeruginosa isolates resistant to imipenem (IRPA). Methods DNA fingerprints of 56 strains isolated from ICU (intensive care unit) were constructed by ERIC-PCR (enterobacter repetitive intergenic consensus-PCR). MICs (minimal inhibitory concentrations) were determined by agar dilution method.Results 33 genotypes were got from 56 strains by ERIC-PCR. Of 8 frequently used antibiotics, 5 of them showed resistance rate higher than 50%. Conclusion It is high time to pay attention to multi-drug resistance of IRPA. The exist of prevalence of IRPA clone in ICU advise us to control of IRPA in hospital effectively.