Objective To study the independent risk factors of early rebleeding after endoscopic variceal ligation (EVL) and/or endoscopic injection of fibrin tissue adhesive.Methods Data of 370 patients who had cirrhosis and accepted 396 procedures of EVL and/or endoscopic injection of fibrin tissue adhesive were retrospectively studied.Independent risk factors for early rebleeding were determined by Logistic regression analysis.Results Results of all the factors that were significantly different between the re-bleeding and non-rebleeding patients,the portal vein diameter,ascites volume,Child-Pugh score and serum albumin were independent ones of early rebleeding after EVL and/or endoscopic injection of fibrin tissue adhesive ( P ＜ 0.05).Larger volume of ascites,wider portal vein diameter,reduced albumin,Child-Pugh score greater than 10 were indicative factors of rebleeding.Conclusion The early rebleeding rate after EVL and/or endoscopic injection of fibrin tissue adhesive is determined by portal vein diameter,ascites volume,ChildPugh score,and serum albumin.

This paper introduces reformation of course system for five-year clinical medicine specialty in three aspects: orientation of course arrangement ,basic structure and major features of new teaching model. By adjusting the teaching plan and setting up new course system optimally, we have made an active attempt on new teaching model for bringing up high-quality medical talent.

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.

AIM:To observe the effect of the extract of Ginkgo biloba(EGB)on pituitary-testicular axis and the mRNA expressions of luteinizing hormone receptor(LHR)and steroidogenic acute regulatory protein(StAR).METHODS:Thirty male Sprague-Dauley rats were divided into three groups randomly:normal control group,type II diabetic group and EGB treatment group.After fed with high-fat diet for 4 weeks,the later two groups were injected with strepozotocin intraperitoneally to induce type II diabetes mellitus.The EGB treatment group was given EGB at the dose of 50 mg/kg once a day for 12 weeks by intragastric administration.The normal control and diabetic group were given normal saline of equal volume per day for 12 weeks.The indices of blood glucose,insulin and low-density lipoprotein-cholesterol(LDL-c)were measured.The morphologic change of testicular tissue was observed under light microscopy(LM)and transmission electron microscopy(TEM)respectively.The concentrations of blood luteinizing hormone(LH)and testosterone(T)were assayed by the technique of enzyme linked immunosorbent assay(ELISA).The mRNA expressions of LHR and StAR from Leydig cells were detected by RT-PCR.RESULTS:The concentrations of blood glucose,insulin and LDL-c increased obviously,and the testis weights lessened obviously in type II diabetic groups compared to those in normal control groups.Rare spermatogenic cells of seminiferous tubule and germinal arrest were observed in diabetic group under LM.Ultrastructural analysis of testicular tissue by TEM showed dilation of the endoplasmic reticulum and mitochondrial swelling in Leydig cell and sertoli cell in diabetic group.The level of blood LH and T decreased in typeⅡ diabetic groups in comparison with that in the normal control group.Compared to normal groups,the mRNA expression of StAR in type Ⅱ diabetic groups decreased,while the mRNA expression of LHR increased.After the treatment of EGB,the pathological change of testis was relieved,the concentrations of blood glucose,insulin and LDL-c were decreased,the level of blood LH and T,and the mRNA expression of StAR were increased,and the mRNA expression of LHR descended compared to type Ⅱ diabetic groups.CONCLUSION:EGB may increase the LH-induced testosterone production by correcting metabolic disorder of glucose and lipid,improving the function of pituitary-testicular axis and regulating the expression of LHR and StAR mRNA.

Objective To study the imaging findings of disseminated pulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS).Methods X-ray and multi-slice CT (MSCT)data from 33 AIDS patients with disseminated pulnonary tuberculosis confirmed by clinical manifestations and laboratory tests were analyzed retrospectively.Results Thirty patients underwent initial chest radiography examination,29 patients showed abnormal appearances,including bilateral disseminations in 21 patients and unilateral multiple disseminations in 8 patients.All patients underwent MSCT examination,26 patients showed bilateral disseminations and 7 patients showed unilateral multiple disseminations.The abnormal pulmonary appearances included nodule (n =25),miliary nodule (n =22),air-space consolidation (n =22),cavity (n =11),fibrosis (n =7),ground-glass opacity (n =7),pneumatocele (n =4),calcification (n =2).There were 20 patients with more than 3 abnormal appearances and 13 patients with one or two abnormal appearances.The extra-pulmonary tuberculosis included pleural effusion (n =33),lymphadenopathy (n =30),intestinal tuberculosis (n =3),splenic tuberculosis (n =1) and cerebral tuberculosis (n =1).Conclusion Disseminated pulmonary tuberculosis should be highly suspected in AIDS patients with diffused nodules,miliary nodules,air-space consolidations or multiple cavities,accompanied with pleural effusion and lymphadenopathy.

ABSTRACT:To improve the ability of correct classification and identification of rodents in different kinds of foci of zoonosis in Ningxia Hui Autonomous Region in China ,rodents samples from different habitats of Ningxia were collected .Sequences of COI gene were amplified and sequenced from 154 samples .Based on these sequences ,the pairwise genetic distance were calcu‐lated ,and a Neighbor Joining tree were constructed .According to the NJ tree ,20 clusters with high bootstrap support were found from 19 morphological species .The striped dwarf hamsters were divided into two clusters ,which suggested that there were two cryptic species with stripe on the back .The pika from Helan Mountain showed close relationship with Ochotona pal‐lasi ,and the genetic distance was as low as 3 .6% .Results show that DNA barcodes could be used to accurately identify speci‐mens of rodents and correct morphological identification errors .It could discover appearance indistinguishable implied species and could better study the classification and evolution of rodents .

Background and purpose:Lower expression of E-cadherin is associated with metastasis of cancer cells, however, the correlation between E-cadherin and glucose metabolism has seldom been reported. This article studied the correlation between E-cadherin and glycolysis effect in PANC-1 cells.Methods:Through treatment of transforming growth factor β (TGF-β) in PANC-1 cells to decrease E-cadherin expression, knock-down the gene of E-cadherin interaction protein β-catenin, and overexpressing of E-cadherin, the effects of E-cadherin on the glucose uptake and lactate production ability and on the expression of key glycolytic genes were assessed.Results:E-cadherin negatively regulated the glycolytic effect of PANC-1 cells by inhibiting glucose uptake and lactate production (P<0.05). Moreover, E-cadherin interacting partner β-catenin signiifcantly promoted glucose metabolism transformation in PANC-1 cells (P<0.05). Moreover, key glycolysis regulator sirtuin 3 (SIRT3) could lower E-cadherin expression.Conclusion:Lower expression of E-cadherin induced the transformation of glucose metabolism transformation in PANC-1 cells and manipulation of E-cadherin expression level could change the glycolysis effect. Moreover, through maneuver glycolysis process could inhibit high metastatic potential of pancreatic cancer cells.

OBJECTIVETo study the effect of Panax notoginseng saponins (PNS) on (synaptophysin, syp) and tau gene expression in the brain tissue in senescence accelerated mouse prone 8 (SAMP 8).

METHODSAMP8 were randomly divided into 4 groups: PNS 23.38, 93.50 mg x kg(-1) group, huperzin A 0.038 6 mg x kg(-1) x d(-1) group and blank control group; the drug groups were treated with the designed drugs respectively per day by intragastric administration for 4 consecutive weeks, and double distilled water was given to blank control group. After treatment, the mRNA content of tau and syp were assayed by reverse transcription (RT) and real-time polymerase chain reaction (real-time PCR).

RESULTCompared with blank control group, the syp mRNA contents were increased in PNS groups (P < 0.05 or P < 0.01), and the tau mRNA content were not significant difference in all groups.

CONCLUSIONThis study suggests that PNS can up-regulate syp gene expression at transcriptional level in the brain of SAMP 8.

Aging ; drug effects ; metabolism ; Animals ; Brain ; drug effects ; metabolism ; Gene Expression ; drug effects ; genetics ; Mice ; Panax notoginseng ; chemistry ; Protein Tyrosine Phosphatase, Non-Receptor Type 11 ; genetics ; metabolism ; Saponins ; pharmacology ; tau Proteins ; genetics ; metabolism

AIM: To explore the role of PI3K/Akt/nNOS in Zhouluotong extract resisting diabetic peripheral neuropathy.METHODS:The Schwann cells were divided into normal group ( D-glucose 25 mmol/L) , model group ( D-glucose 100 mmol/L) , Zhouluotong extract Z-6 +high glucose group, Zhouluotong +high glucose group, mecobalamine+high glucose group.The viability, nitric oxide content and the Ca2+-ATPase activity in Schwann cells were determined by Cell Counting Kit-8 , nitric oxide assay kit and Ca2+-ATPase assay kit, respectively.The apoptosis of Schwann cells were analyzed by flow cytometry.The expression of Bcl-2, Bcl-xL, Bax, Bak and caspase-3, and the phosphorylation levels of nNOS and Akt were determined by Western blotting.The signal pathway of PI3K/Akt was explored by dominant negative PI3K and Akt (δp85 and DN-Akt) transient transfection assay.RESULTS:Under high-glucose culture, the cell viability, nitric oxide content in culture supernatant, the expression of Bcl-2 and Bcl-xL, and the phosphorylation levels of Akt and nNOS in the Schwann cells were significantly increased.The cell apoptosis, the expression of Bax, Bak and caspase 3 in the Schwann cells were significantly decreased by Zhouluotong extract Z-6, compared with model group.In-creased nitric oxide content and the up-regulation of nNOS were observed.However, the effects of blocking PI3K/Akt, the upstream pathway of nNOS , by transfection with DN-δp85 on Akt phosphorylation in the Schwann cells was still unclear. CONCLUSION:Zhouluotong extract Z-6 changes the phosphorylation of nNOS, and the expression of anti-apoptotic fac-tors , caspase-3 and pro-apoptotic factors in Schwann cells under high-glucose culture, thus reducing apoptosis and elevating viability.The relationship to PI3K/Akt/nNOS pathway needs further investigation.

Objective:To research the application of deliberated Teach-back combined with Internet+nursing clinical pathway on Gartland type Ⅲ supracondylar fractures.Methods:A total of 51 children with Gartland type III supracondylar fractures who were hospitalized from March 2018 to May 2018 were selected as the control group, and 46 children with Gartlnd type III supracondylar fractures who were hospitalized from June 2018 to August 2018 were selected as the experimental group. The control group was given the traditional perioperative care routines, and the experimental group was given the Internet + perioperative clinical pathway combined with Teach-back for perioperative period.The execute accuracy of fasting and banned drinking was checked between the two groups, the incidence of postoperative needle infection was compared between the two groups, the function of the elbow joint was evaluated according to the Flynn score, the hospitalization days and hospitalization expenses were compared between the two groups.Results:The execute accuracy of fasting and banned drinking was 64.71%(33/51), 58.82%(30/51) in the control group and 86.96%(40/46), 84.78%(39/46)in the experimental group, and there were statistically significant differences between the two groups( χ2 values were 6.431, 7.937, P<0.05 or 0.01). The incidence of postoperative needle infection was 35.29%(18/51) in the control group and 2.17%(1/46) in the experimental group, and there were statistically significant differences between the two groups( χ2 value was 16.844, P<0.01). The difference of Flynn scores after 4 weeks operation between the two groups was statistically significant( P<0.01), but there was no significant difference after 6 weeks operation between the two groups( P>0.05). The hospitalization days and hospitalization expenses were(2.03±0.04) d, (10 135.403±94.384) yuan RMB in the experimental group, and (4.94±0.14) d, (12 577.646±192.604) yuan RMB in the control group, and there were statistically significant differences between the two groups( t values were 21.256, 11.386, P<0.01 or 0.05). Conclusions:The use of Teach-back combined with Internet + nursing clinical pathway on the Gartland type III supracondylar fracture of the humerus can improve the accuracy of preoperative fasting and banned drinking execut and reduce postoperative needle infection. The elbow function of the affected limb is significantly improved 4 weeks after operation. The hospitalization days and hospitalization expenses are reduced and the effect is significantly better than regular care, Which has the value of further clinical research and promotion and application.