Tumor in the caudate lobe is difficult for surgical treatment due to its unusual local anatomy.As the development of surgical techniques,the success rate of caudate lobectomy is increased.In recent years,the concept of precision hepatectomy aiming to reduce the iatrogenic damage from hepatectomy and improving the recovery of patients on the basis of radical treatment has been raised.This article summarized the experiences of precision hepatectomy for the treatment of huge tumor in the caudate lobe which was performed in the Ruijin Hospital of Shanghai Jiaotong University.With the help of precision hepatectomy concept and techniques,a more satisfactory result both in safety and prognosis was achieved.

Endomorphins(EMs),two tetrapeptides, were discovered in 1997 and believed to be endogenous ligands of μ-opioide receptor(MOR). They mediated various physiological processes by binding to MOR that couple with G-proteins. Based on our works and literatures, we reviewed the distribution in nerve system, receptor binding properties, analgesis, effects on ion channels, conformation and struction-activity relationship of EMs.

AIM　To analyze the effects of endomorphins (EMs) and their analogs (［D-Pro2］EM-1, ［D-Ala2］EM-1, ［D-Pro2］EM-2 and ［D-Ala2］EM-2) on the cardiovascular system of anesthetized rats and to study its mechanism. METHODS　Responses to EMs and their analogs were investigated in the systemic vascular bed of rats and the mesenteric microarteria of Bufo gargarizans. Responses to EMs were investigated on the hindquarters of the rat vascular bed under constant-flow conditions and on the isolated rabbit thoracic aorta strips. RESULTS　The EMs and their analogs showed dose-related (10-9-10-6 mol*L-1, iv) and naloxone-sensitive (2 mg*kg-1, iv) hypotension in mean arterial pressure of rats with similar duration and vasodilatation in mesenteric microarteria of Bufo gargarizans. The sequence of potencies was EMs > ［D-Pro2］EM-2 > ［D-Ala2］EM-2 > ［D-Ala2］EM-1 > ［D-Pro2］EM-1. EMs were shown not to relax the isolated rabbit thoracic aorta strips without endothelium. EMs, however, relaxed them with endothelium significantly. This action was blocked by Nx (10-5 mol*L-1) and L-NNA (10-4 mol*L-1). CONCLUSION　The significant hypotensive activity of EMs and their analogs is mainly associated with their vasodilatation, which is related to the release of NO from vascular endothelium, and their potency is not completely related to their affinity for μ-opiate receptor.

Objective To seak a available way of evaluating morphology of filtering blebs after trabeculectomy is very important for forecasting the successful rate of surgery.At the present time,filtering blebs were commonly evaluated by using the slim lamp microscope,but it did not to exactly reflect the filtering passage.This study aimed to evaluate the morphology of filtering blebs after trabeculectomy with anterior segment optical coherence tomography (AS-OCT).MethodsThis was a prospective study.Sixty-nine eyes of 53 patients who had previously undergone trabeculectomy were selected in this study,including 25 eyes with open-angle glaucoma,38 eyes with close-angle glaucoma and 6 eyes with secondary glaucoma.These filtering blebs were classified into functional type (typeⅠandⅡ) and nonfunction type (type Ⅲ and Ⅳ) under the slit lamp microscope based on the van Buskirk grading scales.Intra-bleb morphology and structure were characterized as diffuse-like,cystic-like,encapsulating-like and flatten-like by AS-OCT in reference to the Leung method.The consistency between the two methods was evaluated by the Chi-Square test.Written informed consent was obtained from all the patients before surgery.ResultsThe average follow-up time was 10.78±11.0 months.All the patients finished the examination during the follow-up duration.The average intraocular pressure was(14.9±4.5)mmHg during the observation period.There were 38/69 (55.1%) functioning blebs and 31/69 (44.9%) non-function blebs under the slim lamp microscope.AS-OCT imaging showed diffuse-like blebs in 26 eyes (15.9%),cystic-like blebs in 11 eyes (27.5%),encapsulating-like blebs in 19 eyes (18.8%) and flatten-like in 13 eyes with the intraocular pressure of(13.16±3.77)mmHg,(15.36±2.92)mmHg,(15.77±5.07)mmHg and (16.62±5.33)mmHg,respectively,showing a significant difference among them (F=3.32,P＜0.05).These patterns of different OCT presented a good consistency with the clinical outcome (χ~2=0.03,P=0.86).ConclusionAS-OCT allows the observation of filtering blebs after glaucoma surgery.It is probably to visualize the internal structure of filtering bleb and deep sclerectomy.Functional and dysfunctional filtering blebs delivery gives different OCT patterns.This could be a new way to assess the postoperative healing process.

Objective To evaluate the diagnostic significance of detecting serum-DNA concentration and clonal gene rearrangement in lymphogenous malignant patients.Methods Serum-DNA in 72 diagnosed patients were measured and analyzed by SPSS11.0.Serum and mono-nuclear cells samples were collected. IgH CDRⅢ, TCR?V9 region were amplified by PCR.Results The serum-DNA concentration of disease groups were (418?172)?g/ml,(426?192)?g/ml, (388?170)?g/ml and(400?110)?g/ml, each was higher than those of control group(77?47)?g/ml(P0.05).Conclusion The concentration of serum-DNAwere higher in lymphogenous malignant patients and tumor associated DNA could be easily detected, so they have important diagnostic value in lymphogenous malignant patients.

Objective:To understand the current situation of effective teaching behavior of clinical nursing teachers and analyze it.Methods:A convenient sampling method was used to conduct a questionnaire survey on nursing students and teaching teachers in Tai′an City central hospital and the Second Affiliated Hospital of Shandong First Medical University, using Cui Shasha Chinese version of Nursing Clinical Teacher Effectiveness Inventory as the research tool.Results:The score of the teachers in the "interpersonal relationship" dimension was the highest (6.32±0.89), while the score in the "nursing ability" dimension was the lowest (5.95±0.99). There was no statistically significant difference between college students and undergraduate students in the evaluation of effective teaching behaviors of teachers, while there was statistically significant difference between nursing students (including college students and undergraduate students) and teachers in all dimensions and total scores of the scale ( t values were -4.616--2.250, P<0.05 or 0.01). Teachers and students were more consistent with the 10 items with low scores than the 10 items with high scores (the total number of items was 2 and 5, respectively). Conclusions:The teaching teacher should be able to correctly identify and judge the learning needs of the internship nursing students, so that the teaching effect meets the expectations of the internship nursing students, and should be targeted when teaching internship nursing students of different educational levels as well as focusing on nursing research.

Objective:To systematically evaluate the effects of different umbilical cord time on maternal and fetal outcomes.Methods:Meta analysis was used, CNKI, Wanfang, VIP, PubMed, The Cochrane Library, EBSCO, Web of Science database, etc. were searched. The literatures were screened according to the inclusion and exclusion criteria, and the literature quality was evaluated. Revman 5.2 software was used for data processing and analysis.Results:A total of 9 randomized controlled trials were included. Meta-analysis showed that delayed umbilical cord did not increase postpartum 2,24 h hemorrhage[mean difference ( MD)=-40.69, 95%confidence interval (CI) (-83.05-1.67), P>0.05 and MD=-10.33, 95% CI (-22.47-1.81), P>0.05] and did not prolong the third stage of labor [ MD= 0.32, 95% CI (-0.71-1.35), P>0.05] compared with conventional umbilical cord (early umbilical cord) method. 1,5 min Apgar scores for different neonatal umbilical cord time was not statistically significant[ MD=0.05, 95% CI (-0.02-0.12), P>0.05 and MD=-0.01, 95% CI (-0.04-0.03), P>0.05]. There was no significant difference in neonatal weight [ MD=72.91, 95% CI (-53.98-199.80), P>0.05]. Delayed umbilical cord could improve the newborn's 24 h capillary hemoglobin [ MD=17.69, 95% CI (13.55-21.83), P<0.01] and bilirubin peak [ MD=17.50, 95% CI (11.88-23.12), P<0.01]. Conclusions:Delayed umbilical cord and early umbilical cord did not increase postpartum hemorrhage and prolong the third stage of labor, and had no adverse effects on maternal. The peak levels of capillary hemoglobin and bilirubin in newborns were increased 24 h, but there was no significant difference in neonatal 1 min and 5 min Apgar scores and neonatal weight.

Objective To detect the synergetic effect and mechanism of arsenic trioxide(As2O3)and Trichostatin A(TSA)during inducing apoptosis of HL-60 cells.Methods MTT method was used to test the proliferation of HL-60 cells.Cell cycle and apoptosis were detected by FCM.Semi-quantitative RT-PCR was used to detect the mRNA expression of Bax and Bcl-2 in the cells treated by As2O3 and(or)TSA.Results As2O3 combined with TSA could inhibit proliferation and induce cell cycle arrest at G0 and G1.The percent of apoptosis induced by combination of As2O3 and TSA was obviously higher than that of either As2O3 or TSA.Bax gene expression was increased,while Bcl-2 gene expression was decreased,Bax/Bel-2 ratio was up-regulated.Conclusion Synergetic effect by As2O3 and TSA is remarkable in inducing apoptosis of HL-60 cells.Cell cycte arrest and Bax/Bcl-2 ratio play an important role in apoptosis of HL-60 cells induced by As2O3,TSA or their combination.

Objective To evaluate the prtognostic significance of preoperative serum extracellular matrix protein 1 ( ECM1 ) levels in patients with hepatocellular carcinoma (HCC).Methods Preoperative serum levels of ECM1 were detected by enzyme-linked immunosorbent assay (ELISA) in 117 HCC patients and 53 healthy volunteers.Corrrlations to the clinicopathological characteristics and patients survival were analyzed.Results ECM1 were detected in all the samples of 117 HCC patients and 53 healthy volunteers,the median serum ECM1 level in HCC patients was significantly higher than that in healthy volunteers ( 166.39 vs 108.06 pg/ml,Z =- 7.805,P ＜ 0.001 ).Median serum ECM 1 levels were significantly higher in patients with invasive phenotypes,such as larger tumor size (Z =- 3.454,P =0.001 ),multiple nodule ( Z =- 2.201,P =0.028 ),vascular invasion ( Z =- 4.685,P ＜ 0.001 ),and advanced TN M stage ( Z =-4.610,P ＜ 0.001 ).Patients with lower serum ECM1 level (≤ 180 pg/ml ) have significantly better overall and disease free survival thanthose with higher levels ( ＞ 180 pg/ml).By Cox proportional-hazard model multivariate analysis,high serum ECM1 level ( ＞ 180 pg/ml) was an independent factor for OS and DFS in HCC patients.Conclusions Serum ECM1 levels are significantly correhted to the invasive phenotypes and survival rate.Serum ECM1 level could be used as a predictive marker for HCC recurrence and prognostic factor of HCC patients after surgery.

Objective:To study the effect of OSAHS on adult nasal-cycle.Method:The nasal cycle of 20 healthy adults,18 patients of snoring and 22 patients of OSAHS were examined with acoustic rhinometry,which was performed every 30 minutes in 7 hours.Result:The ratio of nasal cycle in healthy adults was(19/20,95.0%), in snoring patients was(15/18,83.0%),in patients of OSAHS was(15/22,68.2%). The mean alteration amplitude of nasal cycle in healthy adults was significantly larger than that in patients with OSAHS (P<0.05).The distribution of the healthy adults and patients with OSAHS between the typical cycle categories was significantly different(P<0.05).Conclusion:The characteristics of nasal-cycle in of OSAHS patients were different with healthy adults,which maybe owing to change of physical function of nasal cavity.