Objective To explore if Ulinastai reverses hepatofibrosis in rats.Method Rat hepatofibrosis models were induced by TAA subcutaneously injection.18 rats with hepatofibrosis were divided into 2 groups,Ulinastai treatment group (9 rats),normal saline control group (9 rats).AST,ALT,HA,SOD,MDA,LN level were measured and compared between the 2 groups and that of healthy rats (3 rats).Rats liver morphology was observed using HE,Masson stain and type-B ultrasonic.TGF-β1、caspase-3 were detected by immunohistochemistry.Result After 3 weeks Ulinastai treatment,elastic index and SSS score in Ulinastai group decreased significantly compared to pretreatment (t =2.472,P ＜0.05).ALT,AST,SOD,MDA,HA and LN level significantly improved (F =3.862,5.774,3.442,4.157,4.173,3.674,P ＜ 0.05).Compared with NS treatment group HE and Masson staining showed fewer inflammatory cells infiltration in central vein,ballooning degeneration of liver cells,collagen proliferated,hepatic lobules degradation and pseudolobule arise after 3 weeks intervenion.Also in Ulinastai group,TGF-β1、caspase-3 positive cells were much less than that in NS treatment group.Conclusions Ulinastai can reverse rat hepatic fibrosis and alleviate fibrosis degree and collagen fiber deposit.

Objective To explore the effect of diammonium glycyrrhizinate(DG) and astragalus membranaceus (AM) injection on the clinical comprehensive score in patients with acute lung injury (ALI). Methods According to the random number table method,a prospective random controlled study was conducted in which 60 cases of patients with ALI were divided into a study group and a control group(each,30 cases). Both groups received a comprehensive treatment based on the new guidelines,and the study group was additionally given DG and AM injection(DG 150 mg+AM 20 ml)one time per day for 7 days. The scores of lung injury,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and systemic inflammatory response syndrome(SIRS)were measured at baseline,3rd and 7th day after treatment,and ventilation support time and final disease mortality rate were also calculated in all the patients. Results There were no statistically significant differences between the two groups in the scores of lung injury,APACHEⅡand SIRS before treatment and after treatment for 3 days(all P>0.05),with prolonged treatment,the above indexes were significantly reduced compared with those before treatment in the two groups,and the decreases in scores of indexes in study group was more significant than those in control group after treatment(lung injury score:1.31±0.99 vs. 2.29±1.08,APACHEⅡscore:18.43±8.17 vs. 24.23±6.98,SIRS score:1.69±0.89 vs. 2.60±1.04,all P<0.01). The time(hour)for ventilator support in study group was shorter than that in the control group(176.10±57.81 vs. 286.07 ± 156.27,P<0.01),but there was no statistically significant difference in mortality rate between the two groups(13.33%vs.16.67%,P>0.05). Conclusion The results suggest that DG and AM injection improve the scores of lung injury,APACHEⅡand SIRS,and alleviate the lung injury,so that the injection is beneficial to the early weaning from the ventilator to support treatment in patients with acute lung injury,and has certain therapeutic effect on ALI.

Objective To observe the RAS gene mutations in papillary thyroid carcinoma,and to analyse the effects of mutation on clinical characteristics and prognosis.Methods In this study,354 papillary thyroid carcinoma patients were divided into 2 groups according to RAS mutation by DNA sequence analysis.The pathological type,disease progression,recurrence and prognostic difference between the two groups were compared,and regression analysis was performed to evaluate the relationship between different variables and RAS mutation.Results There were 86 patients with RAS positive mutation.A significant difference was found with primary sites (P =0.004),distant metastasis (P =0.027),AJCC stage (P =0.004) and ATA risk stratification (P =0.000) between two groups.RAS positive patients have higher recurrence rate and shorter recurrence-free survival time (P ＜ 0.005) than the negative patients.Furthermore,in the multivariate analysis,the RAS mutation was significantly associated only with the ATA stratification.Conclusions RAS mutation increases risk of recurrence,RAS mutation and ATA stratification might be a valuable diagnostic and prognostic marker of papillary thyroid carcinoma.

This study aimed to evaluate the feasibility and effectiveness of closing the small bowel in an ex vivo porcine model with high-frequency welding device. A total of 100 porcine small bowels were divided into two groups, and then were closed with two different methods. The fifty small bowels in experimental group were closed by the high-frequency welding device, and the other fifty small bowels in comparison group were hand-sutured. All the small bowels were subjected to leak pressure testing later on. The speed of closure and bursting pressure were compared. The 50 porcine small bowels closed by the high-frequency welding device showed a success rate of 100%. Compared with the hand-sutured group, the bursting pressures of the former were significantly lower (P<0.01) and the closing process was significantly shorter (P<0.01). The pathological changes of the closed ends mainly presented as acute thermal and pressure induced injury. Experimental results show that the high-frequency welding device has higher feasibility in closing the small bowel.
Animals ; Feasibility Studies ; Intestine, Small ; surgery ; Suture Techniques ; instrumentation ; Swine

Objective To evaluate the effect of dexmedetomidine on the tolerance to endotracheal tube, on agitation and other complications of patients undergoing transnasal transsphenoidal pituitary tumor resection.Methods One hundred and twenty-four patients aged 18-65 years, ASA physical status Ⅰ or Ⅱ) were randomly assigned to dexmedetomidine group (group D, n=60) and control group (group C, n=62).Group D were given intravenous infusion of dexmedetomidine during the operation and group C with saline.The extubation time, observation time in the post-anesthesia care unit (PACU), the incidence of emergence agitation, cough, postoperative sore throat and hoarseness were analyzed.Results The extubation time [(29.7±11.5) min vs (22.2±8.5) min] and the length of stay in PACU [(41.5±11.8) min vs (35.3±10.0) min] were significantly longer in group D than those in group C (P<0.05).There was no significant difference of the incidence of emergence agitation (26.3% vs 32.3%), cough (49.1% vs 53.2%), postoperative sore throat (14.0% vs 24.2%) and hoarseness (10.5% vs 19.4%) between two groups.Conclusion Intraoperative intravenous administration of dexmedetomidine can prolong the extubation time and the length of stay in PACU.The incidence of agitation, cough, postoperative sore throat and hoarseness was not affected by dexmedetomidine.

An unusual natural product named 2,4,6-trihydroxacetophenone-3, 5-di-C-beta-D-glucoside (18) were isolated from aerial parts of Rhododendron lepidotum grows in Tibet, along with other 17 known compounds: hopenol-B (1), lupeol (2), ursolic acid (3), avicularin (4), quercetin (5), myricetin (6), hyperoside (7), myricetin-3'-O-beta-D-xyloside (8), (+)-taxifolin-3-O-alpha-L-arabinopyranoside (9), (+)-taxifolin-3-O-beta-D-glucopyranoside (10), lyoniside (11), confluentin (12), 2-(4-hydroxyphenyl)-ethyltriacontanoate (13), 2, 6-dimethoxy-4-hydroxyphenyl-1-O-beta-D-glucopyranoside (14), (-)-2-hydroxy-5-(2-hydroxyethyl) phenyl-O-beta-D-glucopyranoside (15), (-)-isola-riciresinol (16) and isofraxoside (17). All the compounds were firstly isolated from this plant as well as compounds 1, 13-18 were reported occurrence in R. spp. for the first time. The structures were identified based on analyses of spectroscopic data and physico-chemical evidences.
Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; chemistry ; Organic Chemicals ; analysis ; isolation & purification ; Rhododendron ; chemistry

We detected Zika virus (ZIKV) in a febrile case returning from Suriname and entry China from Guangzhou Baiyun International Airport Port.Serum and saliva samples were collected from a suspected case returning from Suriname.We detected ZIKV RNA using real-time fluorescence RT-PCR methods by both in-house reagent and commercial detection kits.RT-PCR detection was carried out with saliva sample and sequence analysis was performed.Phylogenetic tree was constructed to analyze the source of imported cases.Real-time fluorescent RT-PCR result showed that saliva was detected ZIKV RNA positive while for serum was weakly positive.A specific 1 500 bp fragment in size was amplified with saliva sample by RT-PCR.Sequence analysis showed 99％ homologous to the corresponding sequence of Brazil ZIKV (GenBank No.KX197250).Phylogenetic tree indicated it was located on African lineage.According to the epidemiological investigation results,clinical manifestations and nucleic acid detection of case,the suspected case was confirmed to infect Zika virus,being the first case from Suriname into Guangdong Province.

Objective To investigate clinical efficacy and prognostic factors of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 322 patients with hilar cholangiocarcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected.Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations.Observation indexes:(1) clinical features and results of assisted examinations;(2) treatments and results of pathological examination;(3) followup and survival;(4) prognostic factors analysis:gender,age,preoperative highest total bilirubin (TBil),preoperative carcinoembryonic antigen (CEA),preoperative CA19-9,preoperative CA242,preoperative CA125,treatment methods and TNM staging.The follow-up of outpatient examination and telephone interview was perfornmed to detect patients' survival up to November 2016.Survival curve was drawn using the Kaplan-Meier method.Survival and univariate analyses were done using the Log-rank test,and multivariate analysis was done using the Cox proportional hazard model.Results (1) Clinical features and results of assisted examinations:among the 322 patients,there were 301 patients with a chief complaint of jaundice.Of the 322 patients,the preoperative highest levels of TBil,DBil,ALT and AST in 322 patients were 3.9-785.2 μmol/L,1.6-410.2 μ mol/L,14.8-484.5 U/L and 21.4-539.8 U/L,respectively.Levels of ALP and GGT in 272 patients were 93.8-1 890.0 U/L and 2.0-1 832.8 U/L,respectively.Seventy-seven of 292 patients had an elevated CEA level,272 of 298 patients had an elevated CA19-9 level,153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level.According to Bismuth-Corlette type,24 patients were detected in type Ⅰ,115 in type Ⅱ,55 in type Ⅲa,63 in type Ⅲb and 65 in type Ⅳ.(2) Treatments and results of pathological examination:Of the 322 patients,104 patients underwent radical resection,including 79 with hilar bile duct resection (9 combined with vascular resection and reconstruction) and 25 with extended hepatic lobectomy (16 combined with caudate lobectomy),and 218 patients underwent palliative treatments,including 134 with external biliary drainage and 84 with internal biliary drainage.Five patients were dead in the perioperative period,of which 2 died of acute liver failure,1 died of systemic infection and multiple organ failure,1 died of acute renal failure and 1 died of acute suppurative cholangitis,septic shock and disseminated intravascular coagulation.Of 263 patients receiving pathological examination,adenocarcinoma was detected in 253 patients (12 with high-differentiated adenocarcinoma,85 with moderate-differentiated adenocarcinoma,33 with low-differentiated adenocarcinoma and 123 with indefinite differentiation),mucinous adenocarcinoma in 5 patients,cholangiocarcinoma in 3 patients and neuroendocrine carcinoma in 2 patients.TNM staging of 322 patients:stage Ⅰ was detected in 8 patients,stage Ⅱ in 53 patients,stage Ⅲ in 132 patients,stage Ⅳ in 96 patients and indefinite stage in 33 patients.(3) Follow up and survival:among the 322 patients,296 were followed up for 12-132 months,with a median follow-up time of 65 months,including 94 with radical resection and 202 with palliative treatments.Among the 296 patients,the median survival time and 1-,3-,5-year survival rates were 10 months,47.1％,20.2％ and 9.5％,respectively.0f296 patients with follow-up,median survival time and 1-,3-,5-year survival rates were 31 months,84.0％,46.2％,25.0％ in 94 patients receiving radical resection and 7 months,29.9％,8.1％ and 2.3％ in 202 patients receiving palliative treatment,respectively,with a statistically significant difference between the 2 groups (x2=78.777,P＜ 0.05).Among the 94 patients receiving follow-up and radical resection,the median survival time and 1-,3-,5-year survival rates were 31 months,82.1％,45.1％,25.7％ in 73 patients undergoing hilar bile duct resection and 35 months,90.5％,49.8％,22.1％ in 21 patients undergoing hepatic lobectomy,respectively,with no statistically significant difference (x2=0.186,P＞0.05).Among the 73 patients undergoing hilar bile duct resection,median survival time and 1-,3-,5-year survival rates were 16 months,57.1％,0,0 in 7 patients combined with vascular resection and reconstruction and 34 months,84.6％,49.5％,27.5％ in 66 patients undergoing simplex hilar bile duct resection,respectively,showing a statistically significant difference (x2 =11.977,P＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that preoperative highest TBil,preoperative CEA,preoperative CA242,preoperative CA125,treatment methods and TNM staging were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2=25.009,18.671,9.359,33.628,94.729,77.136,P＜0.05).Multivariate analysis showed that preoperative highest TBil ≥ 342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ and Ⅳ were the independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma (HR =2.270,2.147,3.166,2.351,95％ confidence interval:1.587-3.247,1.446-3.188,2.117-4.734,1.489-3.712,P＜0.05).Conclusions Prognosis of hilar cholangiocarcinoma is still unsatisfactory.The R0 resection is the key in radical surgery.Preoperative highest TBil≥342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ-Ⅳ are independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma.

Objective To investigate the application of 3 D visualization (3 DV) assisted proximal femoral nail anti-rotation (PFNA) surgery in the treatment of elderly intertrochanteric fracture (ITF).Methods Totally 11 cases of elderly unstable ITF were treated with 3DV assisted PFNA fixation surgery.All these patients were examined with multi-row spiral CT volume scan,and the anatomical data of Dicom was reconstructed through M3 D software.Computer aided design (CAD) was performed based on 3 D reconstruction data,including anatomical data measurement,fracture reduction simulation,and proximal femoral head nail (PFNA) implant parameter design.And the CAD data were showed by S-3DV system during operation to guide the operation.Time of operation,intra-operative blood lose,post-operative drainage volume,hospital stay time and Harris hip score were recorded and compared to the non-3DV assisted PFNA procedure.Results In 3 DV-PFNA surgery,there was no significant difference between the preoperative planned average PFNA size and the implanted average PFNA size (P ＞ 0.05).Compared to the non-3DV-PFNA surgery,3 DV-PFNA surgery has less intra-operative blood lose and post-operative drainage volume,shorter time of preoperative traction reduction and operation (P ＜ 0.05).Harris hip function score of 3 DV-PFNA surgery was better than the conventional surgery 1 week after operation,and there was no significant difference in VAS score I month after operation.The 11 cases treated with 3DV-PFNA technology were healed well,and the rate of complications was lower than the conventional surgery.Conclusion 3DV technique can show accuracy CAD model of ITF,which may play an important role to improve efficiency and accuracy of PFNA surgery.

Objective Under the linkage reform of family doctor service and medical insurance payment ,to study the family doctors′ career cognitive and expectations in order to improve the endogenous power of the family doctor system development ,and push forward the reform with sustainable effects .Methods All the family doctors in Changning were surveyed. There were 154 family doctors surveyed in the first phase of 2013 ,and 143 in the second phase of 2016 .The data were subject to descriptive statistics .Results About 80％ of the family doctors had a clear understanding of the family doctor system in 2016 ,with the proportion of family doctors clearly understanding their duties risen from 55.26％ (84/152)in 2013 to 61.27％ (87/142)in 2016 .Self-assessment of their work value and professional reputation were more positive significantly .70％ of them believed their social status as above average. The proportion of family doctors who were very confident/confident" in the development of community health services and family doctor system increased from 31.72％ (46/145) to 47.20％ (59/125)and from 31.72％ (46/145)to 52.42％ (65/124)respectively .Conclusions The occupational cognition and career expectations of family doctors in Changning district have been significantly improved ,which can guide their behavior towards reform objectives and propel the family doctor system progress smoothly .