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 investigate the effects of estrogen receptor alpha (Erα) gene polymorphism on the efficacy of ursodeoxycholic acid (UDCA) in female primary biliary cirrhosis (PBC) treatment. Methods The polymorphism of Xba Ⅰ and Pvu Ⅱ sites in No. 1 Intron of Erαgene was detected by polymerase chain reaction-restriction fragment length polymorphism in 65 female patients with PBC. The patients were treated with UDCA tablets daily (13-15 mg·kg-1 · d- 1,divided for 3 times oral taking). The variations of patients' serum total bilirubin (Tbil), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyle transpeptidase (GGT) were followed up totally for 24 months. Results Totally the complete follow-up data had been obtained in 60 patients. Four indicators of XX or PP type patients slowly declined till the end of follow-up point still had not reached the effective treatment standard. Four indicators of Xx type patients were also slowly declined, while the effective treatment standard was achieved till the end of follow-up. Four indicators of Pp/pp or xx type patients were rapid declined to the effective treatment standard. The effective rate of UDCA in PBC treatment was 75.0％ (45/60). The distribution difference of Pvu Ⅱ between the UDCA treating effective group and the ineffective group in PP, Pp, pp types patients and XX、Xx、xx types patients was statistic significant (x2 = 12.13、 P = 0.003 and x2 = 9.95 、 P = 0.007 respectively). The distribution difference of Xba Ⅰ between the effective group and the ineffective group with UDCA treatment in XX, Xx and xx types patients was also significant (P ＜0.05). The effective rate of Pp, pp, Xx, xx types patients [82.61％ (19/23)、80.65％ (25/31) 、9/14、83. 33％ (35/42) respectively] was higher than PP and XX types patients (1/6 and 1/4 respectively).Conclusion Erα gene polymorphism influenced the efficacy of ursodeoxycholic acid in treating primary biliary cirrhosis.

Objective To analyse the effect of different blood purification methods on serum cardiac troponinc T (cTnT), cardiac troponinⅠ(cTnI), β2-microglobulin (β2-MG) and interleukin-6 (IL-6) levels in patients with maintenance hemodialysis.Methods 60 uremic patients treated with maintenance hemodialysis were collected.All patients were randomly divided into conventional hemodialysis group (HD group) , hemodialysis and hemoperfusion group (HD+HP group) and hemodiafiltration group (HDF group) , 20 cases in each group.Corresponding dialysis treatment was given, then the serum levels of cTnT, cTnI,β2-MG and IL-6 were detected in all patients post-treatment.Results After treatment, the serum cTnT, cTnI,β2-MG and IL-6 levels in HD+HP group and HDF group were lower than those in HD group (P<0.05).Conclusions Different blood purification methods have different effects on serum cTnT, cTnI, β2-MG and IL-6 levels in patients with maintenance hemodialysis, HDF and HD +HP have better scavenging effect, which has the guiding significance to clinical application.

Objective To estimate the relationship between the parameters used to estimate the depth of anesthesiaMethods Fifty-two ASA I - II patients undergoing choleeystectomy or exploration of eommon bile duet without jaundice were emdled in the study. Premedieation consisted of midazolam 5 mg and atropine 0.5 mg im.30 min before operation. Anesthesia was induced with fentanyl 4 ug.kg-1 , droperidol 0.08 mg.kg-1 , propofol 2 mg. kg-1 and vecuronium 0.1 mg.kg-1 , and maintained with enflurane and continuous infusion of propofol and intermittent intravenous boluses of vecuronium. The patients were intubated and mechanically ventilated. B1S,HRV and BP were continuously monitored and recorded before induction (T1 ) , 1 min(T2 ) , 3 min(T3 ) after intubation, 1 min before skin incision (T4) , 3 min after skin incision (T5), 1 h after induction (T6), 1 min before extubation (T7) and when the patient was conscious (T8). Blood samples were taken at the same intervals for detenninaton of blood propofol and cortisol level (n = 18) by using radioimmunoasscey and HPL, BIS was maintained at 30 ~ 60 during anesthesia by adjustment of propofol infusion rate. Results There was negative correlation between plasma propofol concentration and BIS/MAP; there was positive correlation between HR and MAP. Plasma cortisol level was positively correlated with BIS, MAP and HR and negatively correlated with plasma propofol concentration. Conclusion The LF and HF can reflect the changes in cardiac sympathetic-vagal tension but cannot reflect the depth of anesthesia. Stress response can be controlled by plasma propofol concentration and estimated by BIS,MAP and HR monitoring.

To compare the effectiveness and safety of spinal versus general anesthesia for arthroplasty with respect to deep vein thrombosis(DVT),pulmonary embolism (PE) and epidural hematoma.Randomized controlled trials involving spinal and general anesthesia for arthroplasty were searched.Quality assessment were analyzed according to the Cochrane Collaboration's rule.A total of 12 trials involving 1023 participants met the inclusion criteria,Meta-analyses showed that spinal anesthesia may reduce the incidence of DVT or PE after arthroplagty without anticoagulant.There is no difference in the incidence of DVT and PE when anticoagulant is used.Whether anticoagulant was used or not,no epidural hematoma was observed after using the two anesthesia methods.

Objective:To explore the roles of the caudal ventrolateral medulla(CVLM) in the central anti-hypertensive mechanism. Methods : In 20 urethane-anesthetized SD rats, the effects of I1-imidazoline receptor and ?2-adrenceptor antagonists (microinjection into the CVLM) on the cardiovascular responses induced by intravenous clonidine were observed. Results: Prior bilateral microinjection of mixed antagonist idazoxan (I1-imidazoline receptor and a2-adrenceptor) into the CVLM not only decreased the mean arterial pressure [(-17. 3 ? 6. 9) mmHg, 1 mmHg = 0. 133 kPa, P

Objective To compare the difference in clinical prognosis of patients with low malignant obstructive jaundice treated by percutaneous biliary stent insertion across or above the duodenal papilla.Methods 56 patients with malignant biliary obstruction were reviewed retrospectively.Stents were placed above the duodenal papilla in 31 cases (group A) and across the duodenal papilla in 25 cases (group B).Total bilirubin reduction rate after 4-7 days of the procedure, biliary infection rate and stent occlusion rate were evaluated and compared between two groups.Results Mean survival periods were 180.3±142.5 days for group A and 178.6±137.7 days for group B (P=0.840).Total bilirubin level was decreased by 42.0±43.6% for group A and by 41.4±28.7% for group B after 4-7 days of the procedure(P=0.950);clinical success rates were 93.5% for group A and 92.0% for group B (P=1.0).Post-procedure cholangitis occurred in 7 cases (22.6%) in group A and 5 cases (20.0%) in group B (P=0.815).Stent occlusion rates were 22.6% and 28.0% for group A and group B (P=0.642).Conclusion For patients with lower malignant biliary obstruction, both of the two modalities of stent placement are safe and effective treatment.Stent placement across the duodenal papilla do not increase the development of stent occlusion or cholangitis compared with stent placement above the duodenal papilla.

Objective To analyze the indication,ways,therapeutic effect,dose prescription and complication of skull base tumor treated by Gamma Knife.Methods Clinical data,including general information,method of treatment and therapeutic effect of 278 benign skull base tumors treated by Gamma Knife were studied retrospectively.Results All patients were followed up for at least 2 years.The clinical conditions improved significantly in 130 patients,remained stable in 125 patients,and worsened in 23 patients.The 5 years progression-free survival rate was 89.5%(249/278)by Kaplan-Meier analysis.The results of Log-rank analysis revealed that better results appeared in patients with smaller tumors.≤3 cm compared with those tumors＞3 am(X2=5.41,P=0.02),and in patients experiencing tumor resection compared with those without history of su~ery respectively(X2=3.96,P=0.047).10 of the 11 cases with tumors＞3 cm who were treated by volume-staged prescription achieved local tumor control.Brain edema occurred in 3 patients,apoplexy of tumor in 1 patient,hydrocephalus in 3 patents,dysfunction of cranial nerves in 12 patients.Conclusion For skull base tumor,Gamma Knife is a major choice,with low risk and maybe an alternative for those small tumors.For those residues after craniotomy,Gamma Knife maybe an auxiliary treatment,and it can be cautiously applied in those with large tumors who cannot tolerate surgery for various reasons.

Objective To observe the expressions ofα-catulin and E-cadherin in tongue squamous cell carcinoma (TSCC)tissue, and to explore their relationship with the occurrence and development of TSCC.Methods The expressions ofα-catulin and E-cadherin in 55 cases of TSCC tissue and 10 cases of normal tongue tissue were examined by immunohistochemistry SP method. The relationship between the expressions and the clinicopathological characteristics and the relevance of the expressions ofα-catulin and E-cadherin in TSCC tissue were analyzed.Results The positive expression rates ofα-catulin in TSCC tissue and normal tongue tissue were 69.09% and 20.00%,respectively,and there was difference between them (P<0.01).The expression ofα-catulin was correlated to the histological differentiation,clinical stage and lymph node metastases of TSCC (P<0.05).The positive expression rates of E-cadherin in TSCC tissue and normal tongue tissue were 38.18% and 80.00%,respectively, and there was significant difference between them (P< 0.01 ). The expression of E-cadherin was correlated to the clinical stage and lymph node metastases of TSCC (P<0.05 ). There was a negative correlation between the expressions ofα-catulin and E-cadherin in TSCC tissue (r=-0.466,P<0.01). Conclusion The expressions ofα-catulin and E-cadherin may be associated with the occurrence and development of TSCC,and they could be used as the parameters which predict the malignant degree and prognosis of TSCC.

Objective To evaluate the feasibility and safety of establishing benign proliferative esophageal stenosis model by using stent implantation in experimental rats.Methods A customized self-expanding,metallic and straight tubular stent was used in this experiment (5 mm in diameter and 15 mm in length),on both sides at the stent's middle part there was a protruding barb that was used as a fixation device.Twelve healthy Sprague Dawley (SD) rats were randomized divided into group A (blank control group) and group B (stent implantation group),with 6 rats in each group.Esophageal stent implantation was employed in the rats of group B,and esophageal radiography was separately performed immediately,one and 4 weeks after stent implantation.All the experimental rats were sacrificed 4 weeks after stent implantation.The normal esophageal tissue of the rats in group A and the esophageal tissue at stent site of the rats in group B were collected and sent for pathological examinations,including gross morphology,light microscopy,etc.Results Successful stent implantation was achieved in all rats of group B,and the esophageal radiography performed immediately,one and 4 weeks after stent implantation showed no esophageal stent displacement;no severe complications occurred during the operation or follow-up period.Compared with group A,esophageal radiography reexamination performed 4 weeks after stent implantation in group B revealed that esophageal stricture at stent segment,caused by benign tissue hyperplasia,could be observed.The esophageal stent segment was taken out,its lumen was obviously narrowed under gross observation,and typical benign hyperplasia could be seen under optical microscope examination.Conclusion Using esophageal stent implantation to establish esophageal stenosis model is safe and feasible in experimental rats.The use of esophageal stent with barbs can significantly reduce the incidence of stent displacement.