Liver failure is a clinical syndrome characterized by serious liver damages.It can results from a variety of causes,and the prognosis is usually poor.How to objectively assess the severity of liver failure and accurately predict the prognosis are the hot spots and challenges in studies on liver failure.The assessment criteria and models widely used clinically include:Child-Turotte-Pugh (CTP) score,acute physiology,age and chronic health evaluation(APACHE) Ⅱ/Ⅲ score,King's College Hospital (KCH) criteria,sequential organ failure assessment (SOFA) score and model for end-stage liver disease (MELD) score.Besides,more factors are identified as potential markers in prognosis assessment.This paper reviews the importance of prognosis assessment in liver failure,and introduces current and new systems or markers in prognosis assessment.

Objective To construct a cDNA subtractive library of genes transactivated by c-terminally truncated middle surface protein of hepatitis B virus(MHBs t) with suppression subtractive hybridization technique for cloning genes associated with transactivation. Methods The mRNA was isolated from HepG2 cells transfected with pcDNA3.1(-)-Mt167 and pcDNA3.1(-) empty vectors, respectively, then cDNA was synthesized. After restriction enzyme Rsa I digestion, small-size cDNAs were obtained. Then tester cDNA was divided into two groups and ligated to the specific adaptor 1 and adaptor 2, respectively. After tester cDNA was hybridized with driver cDNA twice and underwent two times of nested PCR and then was subcloned into T/A plasmid vectors to set up the subtractive library. Amplification of the library was carried out with E. coli strain JM109. The cDNA was sequenced and analyzed in GenBank with Blast search after PCR. Results The subtractive library of genes transactivated by MHBs t was constructed successfully. The amplified library contained 94 positive clones. Colony PCR showed that these clones contained 200-800bp inserts. Sequence analysis was performed in 50 clones,and the full length sequences were obtained with bioinformatics method. 23 coding sequences were obtained in total, which consisted of 19 known and 4 unknown ones.Conclusions The obtained sequences may be target genes transactivated by MHBs t, among which some genes coding proteins may involve in cell cycle regulation, immune response and tumour genesis.

Objective To evaluate the model for end-stage liver disease (MELD) and MELD combined with serum natrium level (MELD-Na) in predicting short-term prognosis of liver failure.Methods Clinical data of 322 patients with liver failure admitted in the First Affiliated Hospital of Xinjiang Medical University from April 2003 to April 2012 were retrospectively analyzed.MELD and MELD-Na scores were calculated at diagnosis and one week after the diagnosis,and then △MELD and △MELD-Na were determined.Receiver operating characteristics (ROC) curve and Kaplan-Meier survival curve were used to evaluate the value of the above scores in predicting 3-month prognosis.Results The 3-month mortality rates of acute/sub-acute,acute-on-chronic and chronic liver failure were 77.4％ (24/31),41.7％ (50/120) and 56.1％ (96/171),respectively,and the difference was of statistical significance (x2 =14.273,P ＜0.01).For acute/sub-acute liver failure,the areas under ROC curve (AUCs) were 0.699-0.836 for each scoring system in predicting short-term prognosis,and no significant difference was observed (Z =0.507,0.622,0.712,0.727,0.779 and 0.599,P ＞0.05).For acute-on-chronic liver failure,AUCs were 0.889 and 0.897 for △MELD and △MELD-Na in predicting short-term prognosis,which were higher than those of MELD and MELD-Na scores at the baseline (Z =3.110 and 3.500,P ＜ 0.05),but no significant difference was observed between △MELD and △MELD-Na (Z =0.310,P ＞ 0.05) ; Kaplan-Meier survival curve showed that the 3-month mortality rate for patients with △MELD ＞ 3.5 was 87.8％,and the average survival time was 34.05 d.For chronic liver failure,AUC of △MELD was 0.871 in predicting short-term prognosis,which was higher than that of △MELD-Na (Z =4.229,P ＜0.05) ; Kaplan-Meier survival curve showed that the 3-month mortality rate for patients with △MELD ＞ 4.5 was 89.9％,and the average survival time was 29.08 d.Conclusion For acute/sub-acute liver failure,MELD,MELD-Na,△MELD and △MELD-Na are all satisfactory in predicting short-term prognosis; for acute-on-chronic liver failure,△MELD and △MELD-Na are better than MELD,MELD-Na scores at the baseline; and for chronic liver failure,△MELD is the best indicator.

Objective To investigate the empathy of obstetric nurses and the related factors.Methods Chinese Version of the Jefferson Scale of Empathy was used to investigate the empathy of 80 obstetric nurses in our hospital and the related factors.Results The score on empathy of obstetric nurses was 65~137,averaged 108.87±10.62 and ranked at the medium level.The empathy was mainly influenced by whether the nurses had studied the empathy-related courses and the satisfaction with their occupation and working environment.Conclusion The empathy of obstetric nurses is at the medium level.Their empathy is mainly influenced by whether the nurses have studied the empathy-related courses and the satisfaction of their occupation and working environment.In addition to promote the training,the nursing manager should improve the satisfaction of the occupation and working environment.

Objective To report 3 cases of using the EXIT(ex-utero intrapartum treatment)procedure in the peri-surgical caring of congenital diaphragmatic hernia of neonatus.Methods Preparing and consulting of multiple clinical departments before operation,inhibit uterine contraction to avoid placental abruption.Keep puerperae and their babies warm.Result No complications happened to neither maternity nor neonatus.Conclusion Co-operations of multiple clinical departmens were essential to the successful using the EXIT(ex-utero intrapartum treatment)procedure in the congenital diaphragmatic hernia of neonatus.

Objective To investigate the incidence of trisomy 12(+12) and 11 q23 deletion [ del ( 11q23) ] in chronic lymphocyticleukemia (CLL). Methods Fluorescein labeled DNA probe 12 and sequence specific probe ATM for 11q23 were used to perform inter-phase fluorescence in situ hybridization (I-FISH) assays in 30 patients with CLL. The results were compared with that of conventional cyto-genetic (CC) examination. Results With CC examination , only 4 cases (13.3%) were found to have chromosomal abnormalities, whereaswith I-FISH assay ,8 cases (26.7%) were found to have genomic aberrations, including trisomy 12 in 5 cases , deletion of 11q23 in 3 ca-sea. Conclusion I-FISH is a useful method for detection of genomie aberration in CLL, the significance of trisomy 12 and del (11q23) inpredicting the prognosis of B-CLL need to be investigated further.

Myeloid differentiation factor 88 (MYD88) is a key linker in the Toll-like receptor (TLR) signaling pathway, which plays an important role in the progression of the tumour. Recent studies have shown that the activating mutation of MYD88 L265P has been identified in about of 90% lymphoplasmacytic lymphoma/Waldenstrom's macroglobulinemia and about of 40% diffuse large B-cell lymphoma and other subtypes of B-cell proliferative neoplasms. Different types of B-cell proliferative neoplasms have their own histology, immunohistochemistry and clinical characteristics, thus, mutation rates of MYD88 L265P are different. This review discusses the latest progress of MYD88 L265P mutation in B-cell proliferative neoplasms.

Objective:To retrieve and summarize evidence for prevention of hypothermia at birth in newborn.Methods:Databases such as Up To Date, BMJ Best Practice, National Institute for Health and Care Excellence(NICE), Joanna Briggs Institute (JBI), Cochrane Library, Registered Nurses′Association of Ontario (RNAO), American Heart Association(AHA), Web of Science, PubMed, Chinese Biology Medical Literature database, Wanfang Med Online were searched to collect relevant evidence for prevention of hypothermia at birth in newborn, including guidelines, systematic reviews, evidence summaries and expert consensus. Two researchers independently evaluated the quality of the literature and extracted the data of the literature which met the criteria.Results:Six articles were selected, including 1 clinical decision support system, 2 guidelines, 1 systematic review and 2 expert consensuses. Nineteen pieces of best evidence were summarized.Conclusions:This study summarized the best evidence for the prevention of hypothermia at birth in newborn, and provided evidence-based support for clinical practice.

Objective To investigate the dynamic changes of dead space fraction (VD/VT) and its effect on the prognosis in the patients with acute respiratory distress syndrome (ARDS).Methods Thirtytwo patients with ARDS in EICU of the First Affiliated Hospital of Kunming Medical University from January 2015 to August 2016 were selected and divided into the survival group and the death group according to the 28 d mortality rate.VD/VT on 1-6 d in the two groups was calculated according to the formula.The parameters of basic condition,PaO2/FiO2,APACHE Ⅱ score,LIPS score,PEEP of the two groups were compared.Results LIPS and APACHE Ⅱ scores had statistical difference between the death group and survival group (P＜0.05);VD/VT on 1-3 d had no statistical difference between the two groups (P＞0.05),and VD/VT on 4-6 d in the death group was significantly higher than that in the survival group (P＜0.01).△PCO2,pH and PaO2/FiO2 had statistical difference between the death group and the survival group (P＜0.05).The binary classification Logistic regression analysis found that APACHE Ⅱ,LIPS,△PCO2,VD/VT were the risk factors.VD/VT on the 4th day was selected,its' cut off value was 0.62,and the sensitivity of the prognostic evaluation was 90.0 ％,the specificity was 95.5 ％.Conclusion The dead space fraction is an independent risk factor for the prognosis of ARDS patients,and VD/VT on 4th day could effectively identify the high-risk patients.

Objective:To investigate the expression and mechanism of hepatocyte growth factor (HGF) in multiple myeloma (MM) based on the gene information in Oncomine database.Methods:Information about HGF study in Oncomine database was collected, and the changes in HGF expression level in MM were analyzed. Genecards database was used to collect HGF gene-related proteins, and STRING software was used to draw HGF-related protein network map. The physiological process of protein function enrichment was analyzed by using DAVID online tools. The relationship between HGF expression level and survival of MM patients was analyzed by using DRUGSURV database and its online tools to explore its clinical significance.Results:A total of 445 studies on HGF in different tumors were collected in Oncomine database. In 23 studies, the difference in HGF expression level between tumor tissues and normal tissues was statistically significant ( P < 0.05), including 10 items of increased HGF expression in tumor tissues and 13 items of decreased HGF expression in tumor tissues. In 4 datasets of 3 studies on the differential expression of HGF gene in MM and normal tissues in Oncomine database, the expression of HGF in MM tissues was higher than that in normal tissues (all P < 0.05). Twenty-five HGF-related proteins were collected in Genecards database, including SDC1, YWHAG, RAF1, etc. Protein function enrichment analysis showed that these proteins were mainly enriched in the negative regulation of hydrogen peroxide-mediated programmed cell death, the regulation of synaptic plasticity, the negative regulation of death domain receptors on extrinsic apoptotic signaling pathways, etc., and they were related to PI3K-AKT and tumor-related pathways. Survival analysis based on DRUGSURV database showed that there was no significant difference in overall survival rate between MM patients with high and low HGF expression ( P > 0.05). Conclusions:HGF gene may regulate the apoptosis of MM cells through PI3K-AKT pathway and play a role in the occurrence and development of MM. HGF may be a potential marker of MM, but its value in prognostic judgment needs further research.