Children are the main victim of anemia which is the most common disease in China.It is the first one of "Four Control Diseases" for Chinese government,as well as for WHO.This paper analyses its major epidemic factors and provides strategies on how to prevent it.

Objective To study the perioperative haemodynamic changes of the femoral vein in patients undergoing laparoscopic cholecystectomy (LC) and its significance. Methods The cross-sectional area, the mean velocity, and flow of the femoral vein at four different stages before and after LC, including baseline (BL), pneumoperitoneum (PP), pneumoperitoneum and reverse Trendlenburg position (PP&RT), and postoperation (PO), were assessed by using the color Doppler ultrasonography in 28 patients. Results ①As compared with the stage BL, the femoral venous cross-sectional area increased from 0.72?0.31 cm2 to 1.08?0.31 cm2 (P=0.004), the femoral venous blood velocity declined from 14.23?11.96 cm/s to 5.50?2.63 cm/s (P=0.017), and the femoral venous blood flow decreased from 596.49?477.95 ml/min to 340.41?166.14 ml/min (P=0.018) in the stage PP. As compared with the stage PP, the stage PP&RT revealed an increased cross-sectional area (1.32?0.14 cm2, P=0.039), a decreased blood velocity (4.40?1.75 cm/s,P=0.034), and an approximately unchanged blood flow (346.69?142.66 ml/min, P=0.067). As compared with the stage BL, the cross-sectional area (0.86?0.15 cm2, P=0.222), the blood velocity (11.35?8.02 cm/s, P=0.412), and the blood flow (566.94?348.55 ml/min, P=0.840) were all approximately recovered to the preoperative levels at the stage PO. ②Color Doppler ultrasonography revealed femoral venous stasis in 21 patients, and 15 of them were detected femoral venous blood reflux. Conclusions During laparoscopic cholecystectomy, pneumoperitoneum and reverse Trendlenburg position may decrease femoral velocity and lead to venous stasis and even blood reflux.

Objective To study the effect of flow-restricted arterio-portal shunt(APS)on the liver.Methods Experimental model of APS and flow-restricted APS were reproduced in rats,and its effects on hepatic blood flow(HBF)and portal venous pressure(PVP)were observed,and the changes in liver structure were investigated six months after the operation.Results Compared with that of pre-operation,both HBF and PVP in APS group at the sixth month after operation changed significantly(P0.05).The PVP changed significantly(P0.05).No obvious lesions were found in the liver by histological examination.Significant differences of both PVP and HBF were found at the sixth month between the two groups(P

Objective To investigate the protective effects of ulinastatin on express of GRP 78、CHOP and caspase-12, the molecules related to endoplasmic reticulum stress (ERS),after ischemia reperfusion injury in rats.Methods Ninety rats were equally randomized into 3 groups(n=30): Sham group (S group,n=30), Ischemia -reperfusion group (I/R group, n=30), Ulinastatin group (U group, n=30).Focal transient cerebral ischemia model was established with intralu-minal occlusion fo left meddle cerebral artery .Made through 2 hours of temporary middle cerebral artery occlusion , followed with 24 hours of reperfusion .The pathological results were investigated by HE staining and the cerebral injury situation was e -valuated by neurological deficit scores .Infract volume was measured by TTC staining , apoptosis was detected by TdT -medi-ated dUTP and nick end labeling (TUNEL), and expression of GRP78, CHOP and caspase -12 were meastured by western blot.Results Compared with the S group , the number of apoptotic cells were significantly increase in I /R group and U group (P<0.05);infarct volume and expression of GRP -78, CHOP and caspase-12 were significantly increased in I/R group and U group (P<0.05).The infarct volume and the number of apoptotic cells were significantly less in U group than in I/R group ( P<0.05 ) .GRP78 expression was higher in U group than in I/R group ( P<0.05 ) , however CHOP and caspase-12 expression was less in U group than in I/R group (P<0.05).Conclusion Ulinastatin has a protective effect on cerebral ischemia reperfusion injury , which may related to increased GRP 78, decreased CHOP and caspase -12 expres-sion and to inhibition of the ERS -induced apoptosis pathway .

Objective:To investigate the public attitudes towards violence incidents from the perspective of in-ternet users, by the means of collecting the hospital violence incidents on the internet. Methods:Selected 7 cases of typical hospital violence and divided those comments into three categories, namely,support the medical side,support the patient side and other. The proportions of all kinds of attitudes were analyzed. Summarize the in-centives of hospital violence and analyze the attitudes of internet users from the perspective of social psychology. Results:Internet users had different attitudes to these 7 cases of hospital violence incidents. The proportion of support the medical side was from 0 . 66% to 95 . 82%, and the proportion ofsupport the patient side was from 0. 18% to 81. 25%. This was mainly due to the in-group favoritism, stereotypes, moral judgment and emotional tendencies of internet public opinion and media-induced and other factors. In internet users' view, the low profes-sional ethical quality is considered the most important incentives, and the proportion was 43. 05%. Conclusions:The tendency of the media coverage has an important influence on the attitude of internet users. Policy makers should correctly treat with the two sides of network public opinions, the hospitals should improve the ability to re-spond to public opinion, the media should regulate coverage and publicity.

Objective To explore the value of the spiral CT three-dimensional reconstruction imaging in congenital dislocationof hip(CDH) in children.Methods A total of 45 patients(59 hips) with CDH were checked-up with spiral CT and three-dimensionalreconstruction imaging before operation.The femoral neck anteversion(FNA) and the acetabular index(AI) were measured and alsocompared with the seeing in operation.Results The patients' FNA were all greater than normal,with the greatest was 90?and the smaller was 40?,the average was 42.72??12.06?.Their AI were also greater,with the average of 35.4??9.5?,the acetabulum were hypogenesis with different degreee.Conclusion The 3D CT of hip joint provides precise information of the imaging compare with the X-ray.It is a very useful technique in the FNA and AI measuring and it is also useful for the diagnosis and treatment planning of CDH.

Objective To evaluate the effect of local resection for the tumor of Vater ampulla. Methods seventeen cases of Vater ampullary tumor were subjected to tumor local resection from November 1987 to December 1998, including 3 adenomas and 14 adenocarcinomas confirmed by pathology. Two methods of excision for the tumor were performed, including through duodenum to perform the tumor local resection in 16 cases, and through common bile duct in 1 case. Results Bile duct infection occurred in 3 cases. There was no death in this series. 12 of the 17 cases (70.6%) had been followed up for 4～61 months, median survival time was twelve months. In three benign cases ,one died with another disease 17 months postoperatively, two still alive well 38 and 7 months after operation respectively. In 14 malignancy, 9 cases (64.3%) had been followed up. Of the 9 cases, 6(66.7%) alived ≥ 12 months, 4 (44.4%) 24 months, two(22.2%) 60 months. Conclusions Local resection of the Vater ampulla tumor has advantages, such as small damage ,less bloodlass, quick recovery and less interference of the body, but it must be performed by rich experienced surgeons. It is suitable for patients with a small benign tumor, or in the high risk patients whose carcinoma showed no invasion or metastasis, and it also can be performed in patients such as those with atypical hyperplasia and suspious malignant tumor.

To develop an effective therapeutic HBV DNA vaccine, two eukaryotic expressing plasmids, namely pcDNAS 2 ?S and pcDNAIIF , which respectively encoding HBV middle envelope protein preS 2 ?S and human IL 2/IFN ? fusion protein, were constructed by DNA recombinant technique. After identification by restriction analysis and DNA sequencing, the constructed recombinant plasmids were transfected into COS 7 cells in vitro with transfection reagent Lipofectamine. The expressed product in supernatant was quantified by ELISA , and the biologic activities of IL 2 and IFN ? were assayed by CTLL 2 cell line proliferation and cytopathogenic inhibition, respectively. The results showed that secretive expression of preS 2 ?S and hIL 2/hIFN ? fusion protein peaked at 48h after transfection, and the expression levels were HBsAg(P/N)=7 63, IL 2=10 35ng/ml, and IFN ?=7 90ng/ml. The IL 2 and IFN ? activities in the culture supernatant of COS 7 cells transfected with pcDNAIIF were 998U/ml and 249U/ml, respectively. These results suggested that the recombinant plasmids pcDNAS 2 ?S and pcDNAIIF were correctly constructed and the transfected cells could express secretive active protein.

Objective To analyze the clinical characteristics and therapeutic effects of cutaneous metastasis from cholangiocarcinoma. Methods From 2006 to 2009, clinical data of 6 patients found with cutaneous metastasis from cholangiocarcinoma were reported. Perineural and vascular invasion were all found in the primary cholangiocarcinoma in these 6 cases with cutaneous metastasis and results were compared with 60 cases of cholangiocarcinoma without cutaneous metastasis. Follow-up to the 6 patients with cutaneous metastases was conducted at an interval of three months. Results One patient with mixed hepatocellular and cholangiocellular carcinoma developed cutaneous metastatic tumor and the pathological diagnosis was cholangiocellular carcinoma. Three patients with hilar cholangiocarcinoma and two patients with distal cholangiocarcinoma presented cutaneous metastases. All six cases of the primary cancers and cutaneous metastases were diagnosed as moderately- poorly differentiated adenocarcinoma. And there was perineural and vascular invasion in the primary tumors. Perineural and vascular invasion of primary cancer was found in 17of 60 patients with cholangiocarcinoma and without cutaneous metastasis. The cutaneous metastasis was positively correlated to the perineural and vascular invasion in the primary tumor (χ2 = 12. 7288, P ＜0. 001 ). Two of 6 cases presenting solitary nodular cutaneous metastasis received skin tumor excision. These two patients survived 8 and 10 months respectively. Among four patients with multiple cutaneous metastases,two cases received chemotherapy and survived 3 and 6 months respectively, the other two cases refusing treatment survived 3 and 4 months respectively. Conclusions Cutaneous metastasis usually occurred at cholangiocarcinoma with lower differentation and perineural and vascular invasion in the primary tumor.Solitary nodular cutaneous metastasis could be excised, multiple cutaneous metastases had poor prognosis.

ObjectiveTo determine the serum levels of cytokines associated with vascular endothelial cells before and after treatment with either transcatheter arterial chemoembolization (TACE) or partial hepatectomy in patients with hepatocellular carcinoma (HCC).MethodsThere were 30 patients who received partial hepatectomy (the operation group) and 30 patients who received TACE (the TACE group).Cytokines were measured before and after treatment.ResultsThe serum levels of IL-1β,IL-6,IL-8,VEGF and EGF of the post-TACE patients were significantly lower than the pre-TACE patients.The serum levels of IL-10,IFNγ and TNFα of the post-TACE patients were significantly higher than the pre-TACE patients.The serum levels of IL-1β,IL-6.IL-8,VEGF and EGF in the postoperative patients were significantly lower than the post-TACE patients.The serum levels of IL-10,IFNγ and TNFα of the postoperative patients were significantly higher than the post-TACE patients.ConclusionThe results suggested that the serum levels of angiogenic factors in the postTACE patients were significantly higher than the postoperative patients.The serum levels of the inhibitors of vascular endothelial cells of the post-TACE patients were significantly lower than the postoperative patients.