Objective To assess the long-term efficacy and safety of mid-dosage (13～15 mg?kg-1?g-1) ursodeoxycholic acid (UDCA) treatment for primary biliary cirrhosis (PBC). Methods A systematic review of all randomized controlled trials (RCT) comparing UDCA with placebo was performed. Results Seven trials including 1038 patients were assessed. UDCA could significantly improve liver biochemistry, but had no effect on pruritus and fatigue. In the patients with initial stage Ⅰ-Ⅱ, there was a significant decrease in the histologic progression after treatment with UDCA for 2 years compared with the placcebo group(P=0.03), but there was no significant difference between the two groups when considering overall patients with initial stage Ⅰ-Ⅳ (P=0.08). Meta-analysis showed no significant difference in the incidence of death (odds ratio 0.99, 95% confidence interval 0.62-1.58), liver related death (1.05, 0.53-2.05), liver trans-plantation (0.87, 0.53-1.41), death and/or liver transplantation (0.92, 0.64-1.31) and liver decompensation (0.94, 0.60-1.49) between the UDCA and placebo groups. Conclusions The analysis of RCTs of UDCA versus placebo shows improvement of liver biochemistry, but not improvement of clinical symptoms and survival. UDCA may slow down liver histologic progression in the early-stage patients with PBC.

Objective To explore and describe the sampling methods for aerosol from cooling towers in the centralized air conditioning system, early-warning indicators, the effect factor and present status of contamination by Legionella.Methods Air-conditioning systems were sampled two rounds in 13 guesthouses, markest and bathing spots of Maanshan City in June-August, 2008.Aerosols were collected by fluid-striking microbial aerosol sample collector, while water samples from cooling tower and swelling box were obtained.Legionella were determined respectively for 67 samples by germiculture and polymerase chain reaction.Results The positive rate of Legionella in aerosols by germiculture was 0, meanwhile it was 50.0% by polymerase chain reaction for Legionella pneumophila.The positive rate in aerosols was 90.0% as the air-sampling volume exceeded 400 L.The positive rate of aerosols increased while the operating-time of cooling tower increased.The relative humidity in Legionella positive groups was higher than that in Legionella negative groups.Conclusion The positive result for Legionella pneumophila by polymerase chain reaction should be an important indicator for early-warning for the occurrence and spreading of Legionnaires' disease.The air-sampling volume of over 400 L is available by sampling collector for the detection of Legionella pneumophila by polymerase chain reaction.Risk of Legionella contamination in aerosol would be raised in high-humidity environment.

Objective To explore the application effect of Sandwich teaching method in clinical teaching in the department of neurosurgery.Methods Totally 144 clinical medicine students were divided into 2 groups:Sandwich teaching group (n=72) and traditional teaching group (n=72).The analysis of test and the questionnaire of the students were conducted after the course.Comparison between the two groups was made using independent sample t test and measurement data were expressed as as ± s.P＜0.05 signifies statistically significant differences.Rank sum test was used to compare the distribution of the test scores.Results The test score was statistically higher in Sandwich teaching group than control group [(76.38 ± 10.84) vs.(69.67 ± 10.50)].And the main distribution of the test scores was 70～90 in Sandwich teaching group while 60～80 in control group.Questionnaire showed that the scores of Sandwich teaching group were statistically higher than those ofthe control group in five aspects such as enhancing self-learning ability,improving the ability to analyze and solve problems,and so on.Conclusions Sandwich teaching method achieves good teaching effect and it is worth recommending in clinical teachifig.

OBJECTIVE:To evaluate therapeutic efficacy of Xuebijing injection in the treatment of severe craniocerebral trau-ma. METHODS:67 patients with severe craniocerebral trauma selected from neurosurgery department of our hospital were Treat-ment method divided into treatment group(33 cases)and control group(34 cases). Observation group was given conventional treat-ment,i.g. oxygen inhalation,dehydration,nourish cranial nerve,anti-infection. Treatment group On the basis of the control group was given Xuebijing injection 50 ml/time,tid,ivgtt. PT,TT,PLT,FIB,CK,LA, D-D,blood gas index (PaCO2,PaO2, HCO3-)of 2 groups were observed after 7 days of treatment,and prognosis of 2 groups were evaluated after 6 months as well as therapettin efficacy. RESULTS:After treatment,PT,TT,PLT,FIB,CK,LA, D-D,PaCO2,PaO2 and HCO3- of 2 groups were all better than before,and the treatment group was better than the control group,with statistical significance (P<0.05). The rate of good prognosis in treatment group (78.79%) was significantly better than in control group (55.88%) after 6 months of treat-ment,with statistical significance(P<0.05). CONCLUSIONS:Xuebijing injection in the treatment of severe craniocerebral trau-ma can improve coagulation function,blood gas levels and the inflammatory reaction,and is conducive to improve the patient's prognosis.

Objective To discuss the relationship between prognosis and different surgical procedures for gallbladder cancer in different stages. Methods The clinical data of 107 patients with gallbladder cancer from January 2001 to May 2007 were retrospectively analyzed. The surgical procedure was chosen according to different stages. Results Eighty-one of the 107 patients (75.6%) were followed up with the median time of 5 years. Of the 10 patients with stage Ⅰ gallbladder cancer who had underwent simple cholecystectomy, 9 survived. Of the 8 patients with stage Ⅱ gallbladder cancer, 3 received palliative cholecystectomy and the median survival time was 12 months, which was significantly shorter than 24 months of the remaining 5 patients who received radical operation (X2= 5.698, P <0.05). Of the 42 patients with stage Ⅲ gallbladder cancer, 18 received radical operation, and the median survival time was 24 months, which was not significantly different from 18 months of the 5 patients who received extended radical operation (X2=0.238, P>0.05). The remaining 19 patients received palliative operation, and the median survival time was 6 months, which was significantly shorter than those of patients received radical operation or extended radical operation (X2=5.772, 6.318, P <0.05). There were 47 patients with stage Ⅳ gallbladder cancer. Seventeen patients received extended radical operation and 30 received palliative operation, and no significant difference upon the median survival time was observed among different surgical procedures (X2=0.001,0.694, P>0.05). The complication recurrence after the extended radical operation was significantly higher than palliative operation (X2=6.039, P<0.05). Conclusions For patients with stage Ⅰ gallbladder cancer, simple cholecystectomy is preferred. Radical operation is good for patients with stage Ⅱ gallbladder cancer. The choose of radical operation or extended radical operation for patients with stage Ⅲ gallbladder cancer should be based on the condition of invasion. Palliative operation could be used to patients with stage Ⅳ gallbladder cancer.

Consensus Development Conferences as Topic ; Endoscopy ; Europe ; Humans ; Nose Neoplasms ; diagnosis ; surgery ; Skull Base Neoplasms ; diagnosis ; surgery

Adolescent ; Ethmoid Sinus ; Humans ; Male ; Osteoma ; complications ; Skull Neoplasms ; complications ; Vision, Low ; etiology

Anastomosis, Surgical ; adverse effects ; Brachiocephalic Trunk ; pathology ; Hemorrhage ; etiology ; therapy ; Humans ; Larynx ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Trachea ; surgery ; Tracheal Stenosis ; etiology ; surgery ; Tracheotomy ; adverse effects

Objective To explore the clinical effects and prognostic factors of postoperative radiotherapy for malignant gliomas. Methods From June 1998 to October 2007, seventy-eight cases of malignant gliomas patients were treated with radiotherapy after surgery, including -28 cases received whole brain radiotherapy, 34 cases local field irradiation and 16 cases three-dimensional conformal radiotherapy. Thirty-one cases received chemotherapy which included semustine, semustine plus teniposide and temozolomide. Kaplan-Meier survival analysis and COX regression analysis were used to analyze the prognostic factors. Results The median survival time and 1-, 3-, 5-year survival rate were 16 months, 65.4 %, 32.8 % and 17.9 % for all patients, respectively; 24 months, 72.7 %, 41.5 % and 22.8% for grade 1 patients; 11 months, 47.8 %, 10.9 % and 5.4 % for grade IV patients. Univariate analysis showed the age, Karnofsky, pathologic grade, surgical approach and the time from surgery to radiotherapy were significantly correlated with the survival time (P <0.05). Karnofsky (P =0.000), pathologic grade (P =0.004) and age (P =0.011) were independent prognostic factors in the multivariate analysis. Conclusion Prognosis of the patients with Karnofsky ≥70, age < 50 years and grade Ⅲ is better in malignant gliomas. Postoperative radiotherapy combined with chemotherapy may prolong the survival time.

Objective To investigate the effect of tumor necrosis factor alpha ( TNF-?) in combination with Go6976 on murine liver cancer cells (H22). Method H22 cells were divided into two groups. Each group was further divided into four subgroups. Group 1 was treated with TNF-? 0, 20, 40, 60ng/ml. Group 2 was treated with TNF-? 0, 20, 40, 60 ng/ml and Go6976 (4.6 nmol/ml). The apoptotic rate, protein kinase C alpha (PKC-?) expression and phosphorylation-PKC-? (p-PKC-?) were detected by flow cytometer and Western blotting respectively in 4 h, 8 h and 16 h. Result Treated with TNF-? (0, 20, 40, 60 ng/ml) for 4 h, the apoptotic rates of H22 cells were 2. 44% ? 0. 31 % , 1. 80% ? 0. 32% , 2. 73% ?0. 14% and 3. 05% ?0. 78% respectively, with no change on the expression of PKC-? and p-PKC-?; For 8 h, the expressions of PKC-? and p-PKC-? in H22 cells were up-regulated with increasing concentration of TNF-?; When PKC-? was inhibited with Go6976 at the same time, the apoptotic rates of cells increased significantly, being 2. 90% ?0.39%, 7.76% ?0.35%, 11.43% ?1.05% and 12.96% ?2.44% , respectively. Moreover, PKC-? and p-PKC-? were down-regulated accordingly. When H22 cells were treated with TNF-? only or combined with Go6976 for 16 h, the result was similar to that of 8 h; The apoptotic rate dropped in the group in which PKC-? was inhibited by Go6976 with TNF-? at 60 ng/ml, but the proportion of necrotic cells increased. Conclusion TNF-? up-regulates the expression of PKC-? and p-PKC-? in H22 cells. Inhibiting the activity of PKC-? significantly enhances the toxicity of TNF-? to H22 cells.