Objective To study clinical value of multiple organ dysfunction syndrome (MODS) score to evaluate prognosis for patients with liver failure. Methods A total of 189 patients with liver failure were recruited into the study, 125 deaths and 64 survivals. Their vital sign, platelets count (PLT), prothrombin time (PT) and international normalized ratio of PT (INRPT), fraction of inhaled oxygen (FiO2), arterial oxygen partial pressure (PaO2), serum levels of total bilirubin (TB), albumin (ALB), creatinine (Cr), pressure-adjusted heart rate (PAHR), glasgow coma score (GCS), degree of aacitic fluid (DAF) and stage of hepatic encephalopathy (SHE) were evaluated within 24 hours after admission. Each of the patients scored according to the criteria of MODS score, Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score. Difference in MODS score between death and survival groups was compared and accuracy of prognosis of MODS score, CTP score and MELD score were evaluated by the area under receiver operating characteristic (ROC) curve. Survival time of patients in the two groups classified by their MODS scores was compared with Kaplan-Meier (K-M) survival curve. Results There was significant difference in PT, INRPT, PaO2, Cr, GCS, SHE between death and survival groups, but there was no difference in TB, ALB, PLT, FiO2, PHAR and DAF between them. Mean score of MODS in death group (9±2) was significantly higher than that in survival group (7±1) (t=9.076, P<0.01). The area under ROC curve (AUC) of MODS score (0.814) was close to that of MELD score (0.827), but higher than that of CTP score (0.714). There was significant difference in survival time between the varied groups classified by MODS score (χ2=72.451, P<0.01). Conclusions Clinical value of MODS score is equivalent to that of MELD score in evaluating prognosis for patients with liver failure, even better than that of CTP score, which can be used to evaluate short-term prognosis for patients with liver failure.

Objective To investigate the relationship between mammary ductal hyperplasia and ductal carcinoma by detecting the expressions of Notch1 and Cyclin D1 in various histotypic mammary ductal diseases.Methods A total cases of 44 normal ductal tissues,44 usual ductal hyperplasias.40 atypical ductal hyperplasias,42 ductal carcinomas in situ and 51 invasive ductal carcinomas were included in this study.Expressions of Notch1 and Cyclin D1 were detected by S-P immunohistochemistry.Results There was significant difference of expression of Notch1 among the five subgroups of this study(P<0.01);there were significant differences between every two subgroups(P<0.05)except for normal ductal tissues versus usual ductal hyperplasias and ductal carcinomas in situ versus invasive ductal carcinomas(P>0.05).There was also significant difference of expression of CychnD1 amongthe five subgroups of this study(P<0.01),and there were significant difference between every two subgroups(P<0.05)except for normal ductal tissues versus usual ductal hyperplasias and normal ductal tissues versus atypical ductal hyperplasia(P>0.05).The correlation between Notch1 and Cyclin D1 was negative (r=-0.428,P<0.01).Conclusions There is a relationship between mammary ductal hyperplasia and ductal carcinoma.Decrease of Nowhl or increase of Cyclin D1 expressions may promote nmnmmry ductal hyperplasia advancing to manunary ductal carcinoma.

Objective To investigate the urodynamic measurements in later pregnant women with urinary incontinence. Methods According to the symptoms, a total of 63 volunteers in later pregnancy were divided into two groups including urinary incontinence group and no symptom group. Fourteen women who were married but not delivered were included in control group. Urodynamic study was performed on all women. Results The occurrence rate of urinary incontinence in later pregnancy was 26.98%. The valsalva leak point pressure only occurred on two pregnant women were 50 cmH2O and 67 cmH2O respectively. Compared with the no symptom group, the maximum urethral closure pressure[(83.69±42.55)mmHg vs(108.09±34.95)mmHg, P＜0.05])and the functional urethral length [(30.45±8.42)mm vs (37.60±18.45)mm ,P＜0.05]of urinary incontinence group were decreased obviously. Conclusions The main reason of urinary incontinence in pregnancy was that the maximum urethral closure pressure could not sufficiently increase to compensate for the progressive increase in bladder pressure during pregnancy and functional urethral length could not correspondingly increase along with the pregnancy.

Objective To explore skills and values of needle-knife in difficult papillosphincterotomy.Methods 222 cases underwent needle-like fenestration(NKF),and other 194 cases directly underwent needle-knife papillotomy(NKP) using needle-knife.Results The success rate of operation in the NKF Group and NKP Group was 75.2%(167/222) and 97.9%(190/194) respectively,with total success rate 85.8%(357/416).Infections of biliary tract occurred in 5 cases(1.2%) after operation,in which 3 cases were treated by surgical biliary tract drainage,2 cases were placed drainage tubes under endoscope once again and administrated antibiotics for controlling infection.Pancreatitis occurred in 24 cases(5.8%) postoperatively,in which 1 case of acute severe pancreatitis was cured with abdominal paracentesis drainage in 3 sites,other 23 cases were given medical conservative treatment.1 cases had massive bleeding of incision and was cured by injecting sclerosing agent under endoscope.Conclusions Using niddle-knife can make papillotomy successful in most of standard EST or pre-cut failure.The success rate of NKP is significantly higher than that of NKF,and re-NKP can improve the success rate without increasing severe complications and death mortality,but NKP should be restricted to duodenal hypo-papilla and stenotic terminal of common bile duct.

OBJECTIVE:To find out a cost-efficient antibiotic prophylaxis of p ul monary and esophageal surgery by way of pharmacoeconomic analysis METHODS:To c ompare the efficacy and cost between short-term and long-term of prophylactic uses of ceftriaxone in pulmonary and esophageal surgery by randomized controlled study and cost-effectiveness analysis RESULTS:Single-dose ceftriaxone regim en and four-dose ceftriaxone regimen were equally effective in preventing posto perative infections in pulmonary and esophageal surgery,the average cost per pa tients for single-dose ceftriaxone regimen(1 257 84?769 67)yuans was signi ficantly lower than that for four-dose ceftriaxone regimen(1 786 69?652 83 ) yuans,P

Objective [WT5”BZ]To observe the efficacy of vitreoretinal surgery in the treatment of early traumatized eyes with no light perception. [WT5”HZ]Methods [WT5”BZ]We performed vitreoretinal surgery on 17 eyes of early traumatized eyes with no light perception.The patients were followed up for 2～14 months. [WT5”HZ]Results [WT5”BZ]Retinal reattachment was achieved in 11 eyes after srugery.8 eyes got visual acuity better than light perception postoperatively.Visual acuities of 5 eyes were better than 0.05 and the best one reached to 0.2. [WT5”HZ]Conclusion [WT5”BZ]Timely vitreoretinal surgery is valuable to the early traumatized eyes with no light perception.Retinal reattachment is the most important thing for the treatment of this kind of cases. [WT5”HZ]

The latest literatures showed that the anti-platelet aggregation drugs had a good application in cardiovascular disease, however still with hemorrhage side effects and some new drugs' mechanism was unknown. So further investigations on the mechanism of anti-platelet aggregation are necessary to discover a new type of anti-platelet drugs, such as antagonists of the EP3 receptor.

ObjectiveTo study the effects of Morroniside on platelet aggregation in rabbits induced by Adenosine diphosphate (ADP), Arachidonic acid (AA), Platelet activating factor (PAF). MethodsThe platelet aggregation was determined by Born's method. ResultsCompared with the controls, Morroniside inhibited platelet aggregation induced by ADP, AA, PAF （P<0.001）and especially selective on ADP. ConclusionMorroniside inhibited platelet aggregation in rabbits, especially induced by ADP.

Objective To compare the effect and complications of lumboperitoneal shunt (LP) and ventriculoperitoneal shunt (VP) in treatment of posttraumatic hydrocephalus (PTH).Methods A retrospective study was made on 150 cases of posttraumatic communicating hydrocephalus managed with LP or VP from June 2013 to June 2015.There were 65 cases [36 males, 29 females;(47.2 ±8.2) years of age] in LP group and 85 cases [53 males, 32 females;(44.6 ± 7.3) years of age] in VP group.Therapeutic effect and complications were analyzed postoperatively.Results Period of follow-up was 3-27 months, which shoued Total effective rate of 97％ in LP group and 94％ in VP group (P ＞0.05).Postoperative complications were mainly hematoma, infection, shunt obstruction, shunt exposure, excessive shunt and inadequate shunt.At the follow-up, there were 3 subdural hematoma, 4 intracranial infection, 2 shunt obstruction, 3 excessive shunt and 1 inadequate shunt in VP group, but 1 subdural hematoma, 1 intracranial infection, 1 shunt exposure and l excessive shunt in LP group.Good results were achieved in the two groups after regulation of the shunt pressure or reoperation.In comparison, incidence of complications was 6％ in LP group versus 15％ in VP group (P ＜ 0.05).Rate of shunt removal and reoperation in LP group were both 2％, but were 7％ and 8％ respectively in VP group (P ＜ 0.01).Conclusions Both shunt procedures are effective for posttraumatic hydrocephalus, while LP is a better choice in clinical application for the lower complication incidence, shunt removal rate and reoperation rate.

Objective To investigate the clinical significance of neutrophil gelatinase-associated lipocalin (NGAL),monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-like apoptosis weak inducer (TWEAK) level in body fluids of lupus nephritis (LN) patients..Methods Levels of NGAL,MCP-1 and TWEAK in the serum and urine of 51 patients with SLE,including 27 LN cases and 24 non-LN cases,were detected by enzyme-linked immunosorbent assay; and the clinical data were collected.Student's t test,Mann-Whitney U test,Pearson's correlations and Spearman's rank correlations were used for statistical analysis.Results (①) The level of serum NGAL in the LN group (122±70) ng/ml was higher than that in the non-LN group (56 ± 34) ng/ml (P＜0.01).There was a positive correlation (r=0.408,0.431,0.339,0.403 and 0.585,P＜0.05) between the serum NGAL and general SLEDAI score,extra-renal SLEDAI score,renal SLEDAI score,the levels of 24-hour urine protein and serum creatinine.There was a negative correlation (r=-0.396,P＜0.01) between the serum NGAL and serum C3 level.There was a positive correlation (r=0.719,P＜0.01) between urinary NGAL levels and chronic index (CI).② The level of serum MCP-1 in the LN group (284 ± 113) pg/ml was higher than that in the non-LN group (173± 69) pg/ml,(P＜0.01).The level of urinary MCP-1 in the LN group (M=1154,P75 41 178,P25 341) pg/mg creatinine was higher than that in the non-LN group (M=456,P75 714,P~ 114) pg/mg creatinine (P＜0.01).There was a positive correlation (r=0.340,0.416,0.385,0.574 and 0.654,P＜0.05) between the serum MCP-1 level and the overall SLEDAI score,extra-renal SLEDAI score,renal SLEDAI score,24-hour urinary protein excretion level and serum creatinine levels.There was a negative correlation (r=-0.458,P＜0.01) between the serum MCP-1 level and serum C3 levels.There was a positive correlation (rs=0.448,0.429,0.459,0.412,0.375 and 0.419,P＜0.05) between urinary MCP-1 level and total SLEDAI score,extra-renal SLEDAI score,renal SLEDAI score,serum ds-DNA antibodies,24-hour urinary protein excretion level and serum creatinine levels.There was a significant positive correlation (r=0.689,P＜0.01) between urinary MCP-1 levels and CI.(③) TWEAK was detected in the urine of 6 cases of LN.Conclusion The urinary NGAL and MCP-1 levels are elevated in patients with chronic damage,which suggestes chronic renal injury.It can be used to monitor the LN disease activity.The blood levels of NGAL and urine MCP-1 are significantly higher in LN.The clinical significance of TWEAK needs further study.