Objective To evaluate the value of three-dimensional ultrasound volume contrast imaging (VCI) and tomo graphy ultrasound imaging (TUI) techniques in observing fetal spinal conus medullaris (CM) position and lumbar enlargement of spinal cord morphologic changes,for assessment of tethered cord (TC).Methods Totally 17 abnormal fetuses of spinal diseases combined with TC (abnormal group) were examined by three dimensional ultrasound VCI and TUI techniques.The position of CM was recorded,and the transverse and anteroposterior diameters of lumbar enlargement of spinal cord were measured and compared with 300 cases of normal fetuses (normal group).Results As the growth of the gestational age (CA),CM terminal position increased.All the ends of CM located at L3 or L3 above level in normal.The transverse and anteroposterior diameters of lumbar enlargement in normal group showed good linear relationship with GA.Transverse diameter (mm) =0.677+0.147 ×GA (R2 =0.836,P＜0.05),anteroposterior diameter (mm)-0.994+ 0.152× GA (R2=0.894,P＜0.05).Compared with the corresponding GA fetuses in normal group,the anteroposterior diameter of lumbar enlargement decreased in abnormal group (P=0.002),while no statistical difference of the transverse diameter was found between the two groups (P=0.082).Conclusion Position of CM and lumbar enlargement measure ment can provide valuable reference information for clinical prenatal diagnosis of fetal spinal TC.

Background: The quality of life has been greatly influenced and the cost of medical expenses is very high in patients with irritable bowel syndrome (IBS). The etiology and pathogenesis of IBS are still unclear, and the prevention and treatment of this disease still lack of effective methods. Objective: To explore and analyze the effects of Tiaohe Ganpi Hexin Decoction (TGHD), a compound traditional Chinese herbal medicine for regulating the liver and spleen, on IBS patients with diarrhea. Design, setting, participants and interventions: All 40 IBS patients came from the First Hospital of Jinan University, Guangzhou Red Cross Hospital, and the First Affiliated Hospital of Guangzhou University of Chinese Medicine, and were randomly divided into two groups. Patients in the treatment group (n=20) were given TGHD, while those in the control group (n=20) were prescribed oral pinaverium with a four-week treatment period. Main outcome measures: Traditional Chinese medicine (TCM) syndrome score, total obviously effective rate, disappearance rate of symptoms, and clinical symptom score in the two groups were evaluated before and after four-week treatment. Results: After the treatment, TCM syndrome scores in both groups were decreased (P<0.01), and the TCM syndrome score in the treatment group was significantly lower than that in the control group (P<0.01). There was a significant difference in the total obviously effective rate between the two groups (P<0.01), and the total obviously effective rates in the treatment and control groups were 85%(17/20) and 45%(9/20) respectively. The disappearance rates of abdominal pain, abdominal distention, poor stool output, stool frequency, stool character and mucous stool in the treatment group were higher than those in the control group (P<0.05). The symptom scores of abdominal pain, abdominal distention, poor stool output, stool frequency, stool character and mucous stool in the treatment group were lower than those in the control group (P<0.05). Conclusion: TGHD can significantly improve the clinical symptoms in IBS patients with diarrhea.

ObjectiveTo investigate the correlation of the serum and synovial fluid interleukin (IL)-1β,IL-6,tumor necrosis factor(TNF)-α and bone marrow edema with osteoarthritis of the knee (KOA).MethodsThe clinical data of 331 KOA patients were included and all patients had knee MRI.Bone marrow edema were detected in 172 cases and 159 cases had non-bone marrow edema.The clinical symptoms,WOMAC score,and the serum and synovial fluid IL-1β,IL-6,TNF-α levels were compared using One-way ANOVA analysis and Spearman's correlation analysis.Results① The serum and synovial fluid IL-1β,IL-6,TNF-α in osteoarthritis was positively correlated(serum r=0.24,0.38,0.31; synovial fluid r=0.20,0.29,0.33 ; all P＜0.05) ; ② The serum and synovial fluid IL-6 and TNF-α levels of osteoarthritis with bone marrow edema were significantly higher than those of the osteoarthritis without bone marrow edema(serum F=8.139,7.172; synovial fluid F=9.201,7.001; all P＜0.05); ③ The serum and synovial fluid TNF-α,IL-6 levels was associated with osteoarthritis with bone marrow edema in volume (serum r,=0.27,0.26; synovial fluid rs=0.29,0.32; all P＜0.05) and severity(serum rs=0.29,0.27; synovial fluid rs=0.29,0.31; all P＜0.05); ④ The serum and synovial fluid IL-1β,IL-6,TNF-α of osteoarthritis with synovitis was significantly higher than that of osteoarthritis without synovitis group (group of bone edema:serum F=3.931,5.866,5.514; synovial fluid F=4.211,5.202,5.972; all P＜0.05.non-bone edema patients:serum F=3.513,3.114,7.112; synovial fluid F=3.722,3.965,8.891; all P＜0.05).ConclusionIL-1β,IL-6,TNF-α are elevated in osteoarthritis with synov-itis.IL-6 and TNF-α are elevated significantly in knee osteoarthritis with bone marrow edema in particular.

Objective To investigate the feasibility of using problem-based learning in nursing clinical teaching in the obstetrics and gynecology department.Methods Sixty-six nursing students were randomly divided into PBL group and lecture-based learning(LBL)group .At the end of their internship,the two groups were compared in terms of examination performance,learning attitude and aptitude,and their feedback on the two learning modes.Results The students in the PBL group were significantly better than those in the control group in terms of examination performance,learning attitude and aptitude,and their feedback on the learning mode(P<0.001).Conclusions PBL may be effective in the improvement of their attitude to learning and aptitude,the comprehensive ability.It can provide an environment to promote internal learning motivation for students.

Objective To analyze the clinicopathologic features of mucinous cervical adenocarcinoma (ADC) and supply some reference for its diagnosis,treatment and prognosis.Methods Totally 88 cases with primary mucinous ADC diagnosed between January 2003 and December 2007 in Jiangxi Maternal and Child Health Hospital were retrieved.Their clinical and pathological data were reviewed and analyzed.Results Among 88 patients,70 cases of them were endocervical ADC,11 cases were minimal deviation adenocarcinoma (MDA),2 cases were intestinal subtype and 5 cases were villoglandular ADC.The positive rate of cervical Pap smear cytology was only 28％ (10/36).There were 10 cases were performed several times of cervical Pap smear cytology test and biopsies,while still no abnormality was found.Finally,7 cases of them were diagnosed by cervical excisional biopsy and endocervical curettage,including 5 cases with endocervical ADC and 2 cases with MDA; 2 cases (1 case with stage Ⅰ b1 endocervical ADC and 1 case with Ⅰ b1 MDA) were diagnosed by cold knife conization,and 1 case with stage Ⅰ b1 endocervical were diagnosed by uteroscopically directed biopsy.The overall 5-year survival rate was 60.0％.Using univariate analysis results showed that age (P =0.046),stage (P =0.007),tumor size (P =0.007) and therapeutic methods (P =0.009) were significant prognostic factors.Multivariate analysis showed that therapeutic methods was an independent predictor for survival (P =0.013).Stage Ⅱ b-Ⅲ b MDA patients occupied 7/11 of all MDA patient,while there was only one such patient of 5 cases with villoglandular ADC.The overall HPV infection rate was 65％ (57/88),and there was no obvious differences about the HPV infection rates among different types of mucinous ADC.Conclusions Cervical smear cytology is of little significance to the diagnosis of mucinous cervical adenocarcinoma.Early stage mucinous ADC is difficult to be detected,especially for MDA.Cervical excisional biopsy,endocervical curettage,cold knife conization,uteroscope are beneficial to its diagnosis.Therapeutic methods is an important prognostic factor for mucinous ADC and comprehensive treatment should be given to those patients with risky postsurgical factors.

BACKGROUND:With the development and improvement of liver transplantation technology, patients waiting for or undergoing liver transplantation have continued to increase in number. Due to their fears and concerns about post-transplantation rehabilitation, patients are under physical and mental stress, most of whom are shown to have a variety of mental disorders that affect rehabilitation. At present, mental problems of liver transplant patients are more concentrated in post-transplantation research, while patients waiting for liver transplantation do not get enough mental assessment and intervention.
OBJECTIVE:To investigate the suitable mode of cognitive-behavioral therapy for liver transplant recipients waiting for donor liver and to evaluate the effect to improve patient’s physical and mental state.
METHODS:Twelve liver transplant patients who underwent pre-transplantation assessment were randomly divided into experimental group and control group, each group with six cases. The control group received conventional treatment. The experimental group received cognitive-behavioral therapy in addition to conventional treatment. Self-rating anxiety scale (SAS) and vital signs were measured in the two groups on admission, 1 week and 3 weeks after admission.
RESULTS AND CONCLUSION:The SAS score of the experimental group was lower than that of the control group at 1 and 3 weeks after admission, and SAS score decreased as the intervention extended. The systolic blood pressure of the experimental group was lower than that of the control group at 3 weeks after admission, but there was no significant difference in diastolic blood pressure between two groups. The heart rate of the experimental group was lower than that of the control group at 1 and 3 weeks after admission. The respiratory rate of the experimental group was lower than that of the control group at 3 weeks after admission. Cognitive-behavioral therapy can reduce the level of anxiety and keep vital signs stable with good feasibility and effectiveness in patients waiting for liver transplantation.

Objective To evaluate the effects of δ-aminolaevulinic acid-photodynamic therapy (ALA-PDT) in the treatment of primary carcinomas on the facial skin. Methods In the accordance of these tumors' sites and morphology, 14 patients with squamous cell carcinoma (SCC), 38 patients with basal cell carcinoma (BCC) and 5 patients with Bowen disease were given four to eight times of topical ALA followed by PDT. Results Ten (71.4%) SCC cases, 34 (89.5%) BCC cases and all (100%) Bowen disease cases completely recovered after ALA-PDT. The others all obtained signifi-cant improvement after final treatment. Their unaffected tissues around these tumors kept well and no scaring appeared after ALA-PDT. The recurrence rates among the completely-recovered cases were 10.0% (SCC), 11.8% (BCC) and 0% (Bowen disease), respectively, by the end of six-month's follow-up. Conclusions Topical ALA-PDT is an effective new therapeutical method with lower recur-rence rates, fewer side effects, no scar formation and excellent cosmetic results for primary carcinomas localizing on the facial skin.

Objective To observe the change in IL-1β,IL-13mRNA expression in drowning rat lungs and serum,so as to investigate the significance of IL-1β and IL-13 mechanism in the development of drowning.Methods SD rats were randomly divided into control group,drowning group.Then using TaqMan probe method to determine the expression of IL-1β and IL-13 mRNA in Right lower lobe of lung tissue and the serum of right ventricle,which were extracted respectively from each group of rats.Results (1) The lung tissue morphological changes:Typical appearance signs and anatomy of drowning group meet ante-mortem drowning feature.(2) The expression of IL-1β,IL-13 in lung tissue:compared with the control group,the expression of IL-1β and IL-13 were slightly decreased,which has no statistical significance.(3) The expression of IL-1β and IL-13 in serum:compared with the control group,the expression of IL-1β and IL-13 were significant increased,both of which has statistical significance.Conclusion (1)The expression of IL-1β and IL-13 were decreased in lung tissue may be due to drowned rats present compensatory anti-inflammatory response syndrome which causes immune incompetent performance.(2) The expression of IL-1β and IL-13 were significant increased in serum may be relate to drown stress and drowning associated acute lung injury after traumatic stress.

Objective To investigate the effects and mechanism of pre-treatment with an Nrf2 inducer dh404 on renal ischemia reperfusion injury in rats.Methods Thirty SD rats were divided into three groups using completely randomized digital table,dh404 was dissolved in sesame oil and was given orally 1.5 mg/kg the night before procedures and 5 hours before procedures.Rats in group Sham received no treatment of ischemic reperfusion.In group IR and group dh404,the renal ischemia reper-fusion (IR)model was established,24 hours after IR,the levels of serum creatininc (Cr)and urea ni-trogen (BUN),the activities of superoxide dismutase (SOD)and the content of malonaldehyde (MDA)in serum were measured,and hematoxylin eosin(HE)staining observe the changes in renal structure,the levels of γ-glutamate-cysteine ligase catalytic (GCLC)and modifier (GCLM)subunit, the expression of NF-κB,COX-2 and eNOS were measured.Results Compared with group Sham,the values of Cr,BUN in group IR and group dh404 were significantly higher (P <0.05).Compared to the group IR,the group dh404 Cr,BUN values significantly decreased after reperfusion for 24 h(P <0.05 ).Compared to group Sham,group IR SOD activity decreased,while the value of MDA increased(P <0.05 ).Compared to group IR,group dh404 had much higher SOD activity,while the value of MDA significantly decreased.Observed with optical microscopy,compared to group Sham, the renal tubular injury of group IR was obvious.Compared to group IR,group dh404 significantly reduced tubular injury.Compared to group IR,the levels of GCLC and modifier GCLM subunit were higher,while there were no significant differences of levels among NF-κB,COX-2 and eNOS. Conclusion Pre-treatment with an Nrf2 inducer dh404 can protect the kidney from IRI through possi-bly reducing IRI kidney oxidative stress.

Objective To investigate the effect of pre-treatment of ginkgo biloba extract from portal vein on oxidative stress in liver surgery.Methods Sixty cases of hepatic portal occlusion for hepatectomy surgery in patients (38 males, 22 females, ASA grade Ⅰ or Ⅱ, cardiac function Ⅰ or Ⅱ, Child-Pugh class A), were randomly divided into three groups (n=20 each): portal vein injection group (group P), jugular vein injection group (group J) and control group (group C).Patients in group P were injected with ginkgo biloba extract injection 5 ml slowly from portal vein after freeing the portal vein, patients in group J were injected with ginkgo biloba extract injection 5 ml slowly from the jugular vein after freeing the portal vein, while patients in group C were injected with normal saline 5 ml slowly from the jugular vein after freeing the portal vein.Venous blood samples were drawn from jugular vein at the following time points: pre-occlusion ten minutes (T0), 1 h (T1), 6 h (T2), 24 h (T3) after reperfusion respectively, and then detected the levels of ALT, AST, tumor necrosis factor(TNF-α), manlondialdehyde (MDA) and the activity of superoxide dismutase (SOD).Results Compared with T0, the serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly increased,the activity of SOD was significantly decreased in all groups (P＜0.05).Compared with group C, serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly decreased, the activity of SOD was significantly increased in groups J and P (P＜0.05).Compared with group J, serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly decreased, the activity of SOD was significantly increased in group P (P＜0.05).Conclusion The pre-treatment of ginkgo biloba extract from portal vein can increase the SOD activity, inhibit the activation of Kupffer cells, reduce the release of TNF-α, enhance the ability of anti-oxidative stress and produce significant protective effect on liver ischemia-reperfusion injury.