Objective To compare the predictive power of model for end-stage liver disease(MELD) and Child-Turcotte-Pugh(CTP) on the cirrhotic patients who underwent transjugular intrahepatic portosystemic shunt(TIPS).Methods A total of 110 patients(98 males and 12 females) undergoing TIPS from January 2004 to March 2008 in our hospital were analyzed.Data of all patients were analyzed retrospectively.The main statistical tests included: Kaplan-Merier analysis to compare survival respectively,and the area of receiver operating characteristics(ROC) to compare the performance of the 2 models for predicting 3-month,1-year,and 2-year mortality.Results The survival rate rate of the patients whose MELD score under 15 showed significantly higher than the patients above MELD score 15.The area of ROC that predicting survival was 0.866 and 0.863 at 3 months,0.755 and 0.739 at 1-year,0.729 and 0.750 at 2-years respectively for the MELD and the CTP score.Conclusion Both MELD and CTP score can predict short-term survival accuracy,but poor in long-term.However,the MELD has overcome the shortcomings of CTP,and may be worth using in clinical.

Objective To investigate the bilateral flow-mediated dilation of brachial artery (BA-FMD) and nitroglycerin mediated dilation (BA-NMD) in patients with cerebral infarct, and to find out if the vasodilation of internal catotid artery after sublingual administration of nitroglycerin can be detected as a more direct way to reflect the vasodilation in patients with cerebral vascular diseases. Methods High resolution ultrasonic system was used to measure 13 patients with acute cerebral infarction. The diameter of brachial artery, internal carotid artery and common carotid artery was measured at relaxation, reactive congestion in the brachial artery and after sublingual administration of nitroglycerin. Meanwhile, the intima media thickness (IMT) and plaques of carotid artery was detected. Results Paralysis did not lead to differences in vasodilation of brachial artery (r=0.52, P=0.07). There was a correlation between ICA-NMD and BA-NMD (r=0.83, P=0.01). Conclusion There were no significant differences between brachial vasodilation in paretic and non-paretic limbs of patients with acute cerebral infarction. Ultrasonic measurement of ICA-NMD can be a more direct measure of the vasodilation of patients with cerebral infarction.

Objective: To study the safety and efifcacy of hematoma aspiration with manual compression for treating the patients of femoral pseudoaneurysm after cardiac catheterization under ultrasound guidance. Methods: A total of 27 patients suffering from post-catheterization iatrogenic femoral pseudoaneurysm were analyzed including 14 male and 13 female at the mean age of (53.5±11.4) years. The body, neck and blood supply area of pseudoaneurysm were located by ultrasonography; 18 gauge needle was punctured into the center of pseudoaneurysm to aspirate blood, meanwhile the neck and body of pseudoaneurysm were manually compressed to block blood supply for relevant artery under ultrasound guidance. Manual compression was conducted for 15 min followed by bandage compression; the patients were lie on the back and kept lower extremity straight for 12 hours. Ultrasonography was performed at 24 hours and 1 month after the operation in all patients respectively. Results: There were 24/27 (88.9%) patients having successful aspiration with manual compression at ifrst time; 2 (7.4%) having incomplete occlusion at ifrst time and the success was obtained by second time; 1 having incomplete occlusion due to coexisted femoral arteriovenous ifstula, while the body of pseudoaneurysm was obviously decreased. The overall success rate was 96.3% (26/27), no procedural complication occurred. Conclusion Ultrasonography guided hematoma aspiration with manual compression has been safe and effective for treating the patients of iatrogenic femoral pseudoaneurysm.

Objective To evaluate the teaching effectiveness of applying article structure analysis to improve medical graduate students' ability to read research articles.Methods 48 medical graduate students from basic medicine school of the Fourth Military Medical University were randomly and equally divided into the experimental group and control group.In the reading ability training of scientific research papers,the experimental group used the teaching of the structure analysis,while the control group used the collective self study.Before and after the training,the two groups of students were implemented a unified reading ability test and self reading ability evaluation survey,and after the training,the teaching satisfaction survey was conducted among the experimental group only.SPSS 16 was used to analyze the correlation data and Wilcoxon for signed-rank t est.Results After training the reading ability test results showed that reading ability score (P=0.013),consumed reading time score (P=0.003) and reading efficiency (P=0.004) of the experimental group were significantly higher than those of control group.The two groups of students' self-evaluation of the reading ability showed that after training,the scores of the students in the experimental group were higher than those in the control group,and the differences were statistically significant (P values were less than 0.05).The experimental group students' teaching satisfaction survey to article structure analysis showed students' score in 6 survey contents were greater than 3,namely degree of evaluation was more than general,among which,the score of four survey contents was more than 4,that is to achieve satisfied or very satisfied.Conclttsion Applying article structure analysis can significantly improve medical graduate students' ability to read research articles.

BACKGROUND: The key factor for cartilage repair is an orient differentiation of seed cells in three-dimensional scaffold; however,clear cartilage is haply observed in the three-dimensional scaffold.OBJECTIVE: To investigate the chondrogenesis of bone marrow mesenchymal stem cells (BMSCs), chondrocytes (CCs) and adipose-derived adult stromal cells (ADAS) in three-dimensional scaffolds METHODS: BMSCs, CCs, and ADAS were primary-cultured from goat bone marrow following trypsin digestion and amplified in monolayer. P1 BMSCs, P3 CCs, and P3 ADAS were implanted into collagen/hyaluronic acid scaffold at different concentrations of 10%, 20%, 50%, 80%, and 100%, and the cells were then three-dimensionally cultured in serum-free culture media. Two weeks later, SO staining and immunohistochemical staining were employed to observe the synthesis between of chondroitin sulfate and type Ⅱ collagen.RESULTS AND CONCLUSION: The seeded cells had chondrogenesis in scaffolds under certain conditions. In details, BMSCs in 20% (W/W) hyaturonan/collagen Ⅰ scaffolds could perform a hyaline-cartilaginous phenotype when they were expanded with less than 3 passages and cultured in a chondrogenic medium, and CCs did better than BMSCs in chondrogenesis with high passage number; however, ADAS just showed a minor chondrogenesis even in a pellet culture. BMSCs and CCs were better than ADAS as seeded cells for cartilage tissue engineering and regenerative medicine.

Objective To observe the variation of mortality and discharge against medical advice in major trauma patients admitted to the ICU and thus to improve the level of trauma care.Methods A retrospective analysis was performed on major trauma patients who died or discharged against medical advice in the emergency 1CU from 2003 to 2011.Patients were categorized as the dying,worse,and improved according to their situation at discharge.The dying was included into the death group.Annual variation of mortality and discharge against medical advice were analyzed in these 9 years.These parameters were also compared among three diverse periods (2003-2005,2006-2008 and 2009-2011).Results Ultimately,452 patients were recruited from the 3,343 major trauma patients admitted to the emergency ICU from 2003 to 2011.There were 231 deaths occupying 6.91％ (135 patients died in hospital and 96 patients were dying at discharge) and 221 discharges against medical advance occupying 6.61％ (175 patients deteriorated and 46 patients improved).Within the 9 years,a significant decrease was found in the annual rate of inhospital death,dying at discharge,and total death.Meanwhile,there was an increase in the rate of deterioration at discharge (x2 =15.305,P ＞0.05).However,no significant difference was found in the rate of total death plus deterioration at discharge.During the three periods of 2003 to 2005,2006 to 2008,and 2009 to 2011,number of patients admitted to the emergency ICU was 687,1,143,and 1,513 respectively.Age and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) of the dead,the patients with deterioration at discharge,and the dead plus the patients with deterioration were gradually higher through the three periods; on the contrary,GCS lowered.Total mortality decreased from 11.06％ to 4.63％ (x2 =31.174,P ＜0.01) ; rate of deterioration at discharge increased continuously from 2.77％ to 6.35％ (x2 =12.203,P ＜0.01) ; rate of death plus deterioration at discharge was declined from 13.83％ to 10.97％ (x2 =4.09,P ＞ 0.05).Conclusions From 2003 to 2011,the level of severe trauma care in emergent ICU is obviously improved.Ratio of deterioration at discharge increases with more aged patients.Discharge against medical advance interferes with the accurate assessment of trauma care and should be paid more attention.

BACKGROUND: Routine methods of chromosome G-bending are complicated, time-consuming and worse in effect, which is not suitable for clinical examination and teaching investigation of chromosomal disorder.OBJECTIVE: To seek for proper method of improving the effect of chromosome G-banding.DESIGN: Observation experiment.SETTING: Xinxiang Medical University.MATERIALS: The experiment was conducted in the Laboratory of Morphous, Xinxiang Medical University between January 2001 and January 2005. 376 blood samples were obtained from patients with infertility and sterility or those had abnormal childbearing history, who came from the Clinic of Gynecology and Obstetrics, Third Hospital Affiliated to Xinxiang Medical College between 2001 and 2004. Main agents: RPMI1640 culture fluid (GIBCO Co., Ltd), 20% calf serum (CS), colchicines, 0.075 mol/L KCL, methanol, glacial acetic acid, trypase (SIGMA Co., Ltd) and Giemsa staining solution.METHODS: Modified method of human peripheral chromosomal preparation and G-banding: The procedures were the same as routine methods, while partial influential factors were regulated, for example, the action time of colchicines was set at 2 hours before the ending; 1 mL of fixation fluid (the ratio of methanol and glacial acetic acid was 2:1) was added for pre-fixation, and samples were mixed and centrifuged at 1 500 r/minute for 10 minutes. After re-centrifugalization,fresh fixation fluid was added to prepare for cell suspension and glass slide by according to the amount of cells.Above-mentioned glass samples were baked at 50 ℃ for 1-2 hours, naturally cooled to 37 ℃, digested for 3-5 minutes by immersing into trypase, rapidly stained for 10 minutes with Giemsa staining solution, and counted by the test under microscope to observe 3 000 metaphases, and the percentages; The percentage of 400-600 metaphases and well-dispersion rate were calculated. Well-dispersion rate of chromosome referred to the overlapping after dispersion with complete numbers. The trabant and kinetic body were obvious and in bright color with clear shape. Moreover, all chromosomes were on the same plane. The percentage of metaphase = the number of metaphase cells (400-600)/number of cells under observation×100%.MAIN OUTCOME MEASURES: The percentage of 400-600 pieces of metaphases in samples and good integration chromosome.RESULTS: 400-600 metaphases obtained with routine methods accounted for 52% with a well-dispersion rate of 68%,while 400-600 metaphases obtained with modified methods accounted for 75% with a well-dispersion rate of 86%, and there were significant differences between the two groups (P ＜ 0.05).the stripes are chear.CONCLUSION:Chromoseme metaphases obtained with modified methods are more in number and good in dispersion with proper size. Giemsa shows that the stripes art chear.

To explore the safety and efficacy of left atrial appendage (LAA) occlusion under the guidance of local anesthesia and modified transseptal puncture technology by coronary sinus assisted positioning in patients with nonvavular atrial fibrillation (NVAF). Methods: A total of 16 NVAF patients received local anesthesia and percutaneous LAmbre or Amplatzer cardiac plug occluder implantation. There were 12 males and the patients mean age was at (71.0±6.0) years with CHA2DS2-VASc score at (4.1±1.5); all patients had walfarin contradiction or with walfarin related side effect. Transseptal puncture was conducted by coronary sinus catheter as the anatomic location marker. Results: All 16 patients finished transseptal puncture and no relevant complication occurred. 15/16 (93.8%) patients had successful LAA occlusion, 1 patient was abandoned because of LAA anatomic structure variation. The mean operative time was (65.0±23.0) min and the mean X-ray exposure time was (12.0±3.0) min. The mean diameter of occluder was (32.5±6.0)mm. Conclusion: LAA occlusion was safe and effective with local anesthesia and modified transseptal puncture technology by coronary sinus assisted positioning in relevant patients.

Objective To investigate the incidence and risk factors of chronic post-surgical pain (CPSP) and its effects on the quality of life in a large sample prospective study.Methods A total of 1098 patients of either sex,aged 18-70 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective surgery,were enrolled in the study.Data regarding patient age,gender,body mass index,educational level,marital status,living situations,occupation,pre-surgical pain in the site of surgery,complications,type of surgery,surgery time and anesthesia method were recorded.The highest numeric rating scale scores within 3 days after surgery were also recorded.The patients were followed up at 3,6 and 12 months after surgery to record the development of CPSP.The patients were divided into CPSP group and non-CPSP group according to whether or not CPSP developed.Multivariable logistic regression analysis was performed to identify the risk factors for CPSP,and the quality of life was scored.Results A total of 981 patients completed the 1 year follow-up after surgery,the incidence of CPSP was 35.7％,and the constituent ratio of the distribution of the course was as follows:3 months ≤ postsurgical course ＜ 6 months was 33.1％;6 months ≤ postsurgical course ＜ 12 months was 16.8％;postsurgical course ≥ 12 months was 50.1％.Female,no diabetes mellitus and pre-surgical pain in the site of surgery were the independent risk factors for CPSP (P＜ 0.05).Compared with non-CPSP group,the physiological function score,professional function score,body pain score,vitality score,social function score,mental health score and general health score were significantly decreased (P＜0.01),and no significant change was found in the emotional function score in CPSP group (P＞0.05).Conclusion The probability of development of CPSP is high and the course is long,and the quality of life score is decreased;female,no diabetes mellitus and pre-surgical pain in the site of surgery are the independent risk factors for CPSP.

Objective To analyze the differentially expressed genes between the NCAM + c-Kit +RBE and NCAM-c-Kit-RBE of intrahepatic cholangiocarcinoma (ICC) cell lines,and to screen out the differentially expressed genes that are related to the stem cell signaling pathways.Methods Magnetic activated cell sorting was used to isolate the NCAM + c-Kit +/NCAM-c-Kit-subset cells,and then Agilent Whole Human Genome Microarray Kit was used to test the difference in gene expressions between the NCAM + cKit + and NCAM-c-Kit-subset cells.The difference in gene expressions related to the stem cell signaling pathways was analyzed by the SAS system.The result of the microarray was further confirmed by RT-PCR.Results The total differentially expressed genes which could be found through gene microarray were 7270 [foldchange(fc) ≥2 or fc ≤0.5].Compared with the NCAM-c-Kit-RBE,3572 genes were upregulated while 3698 genes were downregulated.The differences in gene expressions related to the stem cell signaling pathways were 421 (fc ≥2 or fc ≤ 0.5),among which 231 genes were upregulated while 190 genes were downregulated.Conclusions High-flux microarray could be used to screen out lots of differentially expressed genes between the NCAM + c-Kit + and NCAM-c-Kit-RBE cells.The differences in gene expression in the stem cell signaling pathways could also be further analyzed using the SAS system.