Objective　The conditional hierarchical clustering for 1-dimensional(1-d) ordinal data was discussed.Methods　Because the individuals are ordered in 1-d,the conditional matrix was constructed with all elements in the second-diagonal are 1 and the others are 0.Distance matrix of individuals defined by some particular definition.Then the conditional-distance matrix was made for the hierarchical clustering by connecting the conditional matrix and distance matrix.This method was called 1-dimentsional conditional hierarchical clustering.An example was illustrated by this method and a Monte Carol study showed that method was feasible and robust.Results　Compared with the least-squares partition,this method is easy to understand,easy to practice and easy to compute.It also can give us a stable result.Conclusion　Because of the austere theory,the simple thought and the convenient application,it's a good method for the 1-d ordinal data.

Objective To investigate the role of p38 mitogen-activated protein kinase (p38MAPK) pathway in the protective effect of remifentanil or ischemic preconditioning (IPC) against hepatic ischemia-reperfusion (I/R) injury in rats.Methods One hundred and forty-four male SD rats,weighing 200-250 g,were randomly assigned into 6 group ( n =24 each):sham operation group (group S),I/R group,remifentanil group (group R),IPC group,SB203580 (a specific p38MAPK inhibitor) + remifentanil group (group SB + R),and SB + IPC group.The animals were anesthetized with intraperitoneal 20％ urethane 1 mg/kg.Partial liver ischemia was produced by clamping the hepatic pedicle supplying left lobe and middle lobe for 30 min,followed by 120 min reperfusion.In group R,remifentanil was infused intravenously at 2μg· kg- 1 · min- 1 starting from 30 min before ischemia until the end of reperfusion.In IPC group,the rats were subjected to 3 episodes of 5 min ischemia at 5 min intervals before I/R.SB203580 0.2 mg/kg was injected intravenously at 5 min before remifentanil infusion or IPC in groups SB + R and SB + IPC,and the equal volume of normal saline was given in the other groups.Six rats in each group were selected at 30,60,90 and 120 min of reperfusion and venous blood samples were taken from inferior vena cava for measurement of serum ALT and AST activities and concentrations of TNF-a and 1L-1β.The rats were then sacrificed and liver tissues were taken for microscopic examination and determination of phosphor-p38MAPK expression by Western blot.Results Compared with group S,serum AST and ALT activities and serum levels of TNF-α and IL-1β were significantly increased at each time point (P ＜ 0.05) and pathological injury was aggravated in group I/R.Compared with group I/R,serum AST and ALT activities and serum levels of TNF-a and IL-lβ were significantly decreased and phosphor-p38MAPK expression was up-regulated at 90 min of reperfusion in groups R and IPC ( P ＜ 0.05).The serum AST and ALT activities and serum levels of TNF-α and IL-1β were significantly increased,phosphor-p38MAPK expression was down-regulated at 90 min of reperfusion ( P ＜ 0.05),and pathological injury was aggravated in group SB + R compared with group R,and in group SB + IPC compared with group IPC.Conclusion Activation of p38MAPK pathway and inhibition of inflammatory response may be involved in the mechanism by which remifentanil or IPC reduces the hepatic I/R injury in rats.

Objective To investigate the effects and possible mechanisms of ursolic acid (UA) on inhibiting proliferation of human esophageal carcinoma cell Eca-109 and inducing its apoptosis. Methods Cell proliferation was determined by MTT assay. Electron microscope was used to observe the ultrastructural changes of Eca-l09 induced by UA. Cell cycle and apoptotic rate were analyzed by flow cytometry (FCM),and the expression of P27kip1,Bcl-2 and Bax were detected by Western blot method. Results UA could significantly inhibit the growth of Eca-109 cells(P

According to the Organ Injury Scale Grading System of the American Association for the Surgery of Trauma (AAST-OIS),grade Ⅴ liver trauma is always complicated with retrohepatic inferior vena cava injury and less bile duct injury,and it is extremely severe and difficult to be treated.Timely and fast judgment,emergent exploration and effective repair of the injured bile duct are the key points for the treatment of bile duct injury.One patient with grade Ⅴ liver trauma combined with hilar bile duct transection injury was admitted to the Fuzhou General Hospital of Nanjing Military Command on August 30,2013.The rupture of left and right liver junction was detected by preoperative multidisciplinary consultation and emergency open surgery at admission hour 4.There was left and right hepatic duct bifurcation rupture at the first hepatic hilum.Non-functional liver tissues were excised.Breakage left and middle hepatic vein were sutured by polymer suture line.Liver traumatic bleeding and bile duct were sutured and ligatured individually.Left and right hepatic duct laceration was sutured by 6-0 PDS suture line.A hole in the stomach wall was opened fist,and then most part of the gastric contents was removed and the gastric wall was reparied by stapler.Patient received the postoperative symptomatic treatment with gradual recovery,and was discharged from hospital at admission day 26.The patient was readmitted to the hospital at 31 days of discharge due to outflow of purulent fluid from abdominal cavity drainage tube,and was treated by ceftriaxone sodium and tazobactam sodium according to the results of drug sensitive test and continuous peritoneal lavage.The abdominal cavity drainage tube and left and right hepatic duct drainage tube were removed at postoperative day 83.The patient was discharged from hospital at readmission day 28,and was followed up till December 2014 with good recovery and without complication.

BACKGROUND:After knee joint replacement, patients are often treated with Rivaroxaban and Enoxaparin Sodium for postoperative anticoagulation, avoiding the formation of deep vein thrombosis in lower limbs. OBJECTIVE:To explore the application effects of different anticoagulant drugs in patients with knee joint replacement. METHODS:Ninety patients underwent knee joint replacement in Xiangya Second Hospital of Central South University from July 2011 to July 2014, were randomly divided into two groups, with 45 patients in each group. The experimental group was treated with Rivaroxaban, while the control group was treated with Enoxaparin. RESULTS AND CONCLUSION:Postoperative drainage volume, total blood transfusion, bleeding index, quantity of blood platelet, activated partial thromboplastin time, thrombin reduction time, whole blood viscosity, plasma viscosity, D-dimer coagulation index, HSS score at postoperative 2 weeks, average ecchymosis area, average thigh circumference, and average leg circumference were significantly better in the experimental group, than in the control group (P<0.05). The incidence of deep vein thrombosis of lower limbs in the experimental group was lower than that in the control group (P<0.05). Experimental findings indicate that, both Rivaroxaban and Enoxaparin can exert anticoagulation effect during the knee joint replacement, and Rivaroxaban is better.

Objective To evaluate file efficacy and safty of central venous cathetr compared with conventional chest tube for closed pleural drainage in the treatment of traumatic hemothorax Method Totally 299 patients of traumatic hemothorax with middling or large effusions,in emergency department,Second Hospital .Affiliated to Medical College of Zhejiang University,from January 2003 to May 2007,were prospective controlled studied.All the 299 patients of were divided into catheter group (n=156) or tube group(n=143) according as patients'hospitalization date was odd or even number respectively.Patients in catheter group underwent drainage by central venous catheter using the Seldinger technique,and patients in tube group did by conventional chest tube using conventional technique.A unue drainage bag system or a wate seal system was connected with the end of the catheter or the tube respectively.The surgical operation time,the successful rate of treatment,the occurreuce rate of serious complications,the using rate of anodyne,the time of cut concrescence and the occurrence rate of cut infection were compared,and the drainage time and the correlative expenses in patients treated successfully were further compared.The data were analyzed by using t or X2 test with SPSS 13.0.A P value less than 0.05 indicated statistical signficance.Results Compared with robe group,the surgical operation time,the using rate of anodyne,the time of cut concrescence and the occurrence rate of cut infection were significantly decreased(P<0.05) in catheter group.There were not significant differences between two groups in the suecessful rate of treatment and the occurrence rate of serious complications(P>0.05).There were not significant differences between two groups in the drainage time and the corrective expenses of patients treated successfully(>0.05).Conclusions Use of central venous catheter catheters for closed pleural drainage in the treatment of traumatic hemothorax is effective,safe,and well-tolerated.It was more simple and less invasive as a procedure compared with conventional large-bore chest robe.

Objective To investigate the relationships between the parameters of intravoxel incoherent motion (IVIM)DWI at 3.0 Tesla and T staging of moderately differentiated adenocarcinoma of rectum.Methods Clinical data and MRI findings including con-ventional imaging and IVIM-DWI were collected in a total of 37 patients with moderately differentiated adenocarcinoma of rectum proven by pathology.The patients were divided into two groups without (staging T1 and T2)or with myometrial invasion (T3 and T4).The D,D? ,f and ADC values of rectal cancer and normal rectal wall were measured and were compared between the lesion and normal rectal wall,between both groups and among different T stages.The relationships of the parameters of IVIM-DWI and ADC values with the T staging of moderately differentiated adenocarcinoma of rectum were analyzed.Results The D,D? ,f and ADC val-ues of rectal cancer were lower than those of normal rectal wall with statistical differences in D,f and ADC values (P <0.05).The differences in D and D? values among different T stages were statistically significant,and LSD Duncan test showed that the differ-ence in D? value between T1 and T4 (P =0.01 7)and between T3 and T4 (P =0.003)and in D value between T2 and T3 (P =0.005) were statistically significant.The D,f,D? and ADC values of noninvasion group and invasion one were (0.93±0.1 6)×10 -3 mm2/s versus (0.77±0.1 9)×10 -3 mm2/s,(27.1±2.94)% versus (24.6 ±4.13)%,(12.6±2.44)×10 -3 mm2/s versus (12.3±3.49)× 10 -3 mm2/s,and (0.95±0.09)×10 -3 mm2/s versus (0.87 ±0.12)×10 -3 mm2/s respectively,and the difference in D value was statistically significant (t=2.5 12,P =0.01 7).Conclusion The parameters of IVIM-DWI and the ADC values are different in rectal cancer and normal rectal wall,and the D value may help to identify the tumor invasion into the muscularis propria.

Objective To investigate the expression level of endogenetic nitric oxide(NO) in the reproduction process of human anterior cruciate ligament cells. Methods Anterior cruciate ligament cells were isolated and subcultured from the human anterior cruciate ligament. LPS was used to induce the anterior cruciate ligament cell to express the inducible nitric oxide synthase(iNOS ), and N-monomethyl -L-Arginine (L-NMMA) was used as the interdiction of nitric oxide. They were alone or together added in the culture medium of anterior cruciate ligament cells in different groups. The level of NO was indirectly measured in the medium of HACL. Results LPS promoted significantly anterior cruciate ligament cells to produce endogenetic nitric oxide, compared with the control group(P

Objective:To investigate the KRAS gene mutation features in lung and gastric cancers and their relationship with clinicopathologic characteristics. Methods:A total of 128 lung cancer and 115 gastric cancer patients were included. Polymerase chain reaction amplification and DNA sequencing were conducted to detect mutations in exon 2 of the KRAS gene. Results:The mutation frequency of KRAS was different in lung and gastric cancers;however, it did not show any statistical significance (6.3%vs. 4.3%, P>0.05). The KRAS codon 12 gene mutation ranks the first in both types of cancer. No significant correlation was observed between the prevalence of KRAS mutations and patient's age and gender. KRAS gene mutation rate was higher in lung adenocarcinoma than in non-adenocarcinoma, such as squamous cancer (10.7%vs. 0%, P<0.05). Conclusion:No correlation was found between the KRAS gene mutation and the sex and age of lung and gastric cancer patients in Jiangsu Province. The rate of KRAS mutation was low. KRAS gene mutation rate was relatively higher in lung adenocarcinoma patients;thus, the mutation status of the KRAS gene should be evaluated be-fore undergoing EGFR-TKI therapy.

Objective To analyze the risk factors for complications in elderly patients with cardiac surgery under cardiopulmonary bypass.Methods From July 2004 to June 2012,64 patients aged ≥ 60 years undergoing cardiac operations were selected.Clinical data were collected.The complications after cardiac operation and the risk factors were evaluated by single factor analysis and multivariate Logistic regression analysis with SPSS software.Results The postoperative complication rate in all patients was 34.4％ (22/64).The complications occurred in 42 subjects and operative mortality was 6.3％ (4/64).The single factor analysis showed that chronic obstructive pulmonary disease combined before operation (P=0.001),diabetes combined before operation (P=0.009),cardiopulmonary bypass time ≥2 h (P=0.000),aortic cross clamping time ≥90min (P=0.001),and blood transfusion volume ≥2000 ml (P =0.000) were the important risk factors for postoperative complications.Multivariate Logistic regression analysis revealed that chronic obstructive pulmonary disease (P=0.007) and diabetes combined before operation (P=0.028),cardiopulmonary bypass time ≥2 h (P=0.003),and blood transfusion volume ≥2000 ml (P=0.030) were the significant independent predictive risk factors for postoperative complications.Conclusions Chronic obstructive pulmonary disease,diabetes,cardiopulmonary bypass time ≥2 h,aortic cross clamping time ≥90 min,and blood transfusion volume ≥2000 ml are the independent predictive risk factors for postoperative complications in elderly patients with cardiac surgery under cardiopulmonary bypass.