[Objective] To investigate the change of liver histology, proliferation of BDEC, and expression of TGF-β in different stages of liver chelestusis. [Methods] ①Rat cholestatic livers were induced by common bile duct ligation (BDL) and separated into 3 groups, namely control group (DO), 7 days after BDL group (DT), and 18 days after BDL group (D18). ② Histological changes of livers in different groups were evaluated based on Knodell HAI score. ③ Real-time PCR was used to detect the expression of TGF-β in liver tissue and isolated BDEC in different groups. ④ Statistically analyzing the correlation between Knedell HAl score and the levels of TGF-β_1 mRNA. ⑤ In vitro study was performed to investigate the effect of TGF-β_1 on an immortalized mouse intrahepatic bililary epithelial cell line (mIBEC). [Results] (I) Knedell HAI score and the proliferation of intrahepatic bile ducts increased as the liver cholestasis aggravated. ② The levels of TGF-β_1, TGF-β_2, and TGF-β_3 mRNA were significantly up-regulated in liver tissues and BDEC as the liver cholestasis aggravated. ③ Positive correlation was found between Knedell fibrotic score and the levels of TGF-β_1 mRNA in liver tissues and BDEC(r=0.9376, P<0.05 and r=0.9682, P < 0.01). ④ In vitro study showed that TGF-β_1 inhibited the proliferation of mIBEC. [Conclusion] ① Liver injury, biliary proliferation, and the levels of TGF-β mRNA expression increased as liver cholestasis aggravated. ② The interaction of TGF-β_1 and BDEC plays an important role in the pathogenesis of BDL induced cholestatic liver disease. ④ Up-regulated expression of TGF-β_1 mRNA in the proliferated BDEC participates in the formation of BDL induced cholestatic liver fibrosis.

ObjectiveTo evaluate and compare the outcomes of missed Monteggia fractures in children treated with ulnar angulation-distraction osteotomy and plate fixation or external fixation.Methods Nineteen patients,including 11 boys and 8 girls who presented with missed Monteggia fracture,were reviewed from July 2005 to June 2011.Twelve children (Group A) were treated with ulna angulation osteotomy and plate fixation,and 7 eases(Group B) with ulna angulation-distraction osteotomy and external fixator.Thirteen patients were classified as type Bado Ⅰ,and six as type Bado Ⅲ.The age,the delay from injury to surgery,complications,elbow and forearm function,and the healing time of the osteotomy were compared.ResultsAll 19 patients were followed up.The duration of missed dislocation was from 6 to 36 months (mean,10 months).Redislocation of the radiocapitellar joint occurred after surgery in one case in group A.Forearm compartment syndrome occurred in one case after surgery in group B.All patients,except one,regained full elbow flexion in group A and B,various forearm pronation limitation were noted in all patients (mean,15°).The average healing of osteotomy of group A and B was 8 weeks(6-15 weeks) and 22 weeks (10-44 weeks).ConclusionThe ulnar angulation-distraction osteotomy could correct the ulnar deformity in children of missed Monteggia fractures,which is the key issue to be corrected.Both of the fixation strategies can obtain the same treatment results.Preoperative assessment is most important,plate internal fixation was recommended for young age and short delay cases,on the contrary,we prefer to choose external fixator.

ObjectiveTo evaluate the safety,therapeutic effect and complications of the operation of multi-section osteotomy and intramedullary fixation for children with osteogenesis impeffecta.Methods One hundred and twenty-three children with osteogenesis imperfecta,including 85 males and 39 females,were selected from August 2005 to August 2008.According to the modified Sillence classification,45 cases was in type Ⅲ,74 in type Ⅳ,and 5 in type Ⅴ.Patients' age was ranging from 2 years and 1 month to 15 years and 7 months (mean,8 years and 3 months).The location of osteotomy was established according to the pre-operative measurement of X-ray image,and all the procedures of osteotomy were completed under direct vision.Then we chose the intramedullary pin with suitable size and insert the pin into femur from greater trochanter,and tibia from pelma.After the surgery,external fixation (spica cast for the femur,long leg plaster cast for the tibia) was made for further stabilization.Plaster supporters were removed 6 weeks later and all children began to stand and walk under the protection of orthoses.In addition,all patients received the treatment of pamidronate disodium periodically.ResultsAll 123 children were followed up for an average of 38months (range,13-64 months).Parents of all children were satisfied with the result of surgical operation,and the children's self-care and motion ability improved obviously.Fourteen children were performed the second operation due to the translocation of Rush pin,and 25 children changed the internal fixation because of the shorter Rush pin 2 years postoperatively.Bone delayed union was not found in all patients.Conclusion Multi-section osteotomy and intramedullary fixation for children with osteogenesis imperfecta could correct skeletal deformity,improve motion ability and avoid second fracture efficiently.However,such complications as translocation of intramedullary pin and changing the internal fixation with the growth of child need to pay more attention.

Objective To compare the effects of loop electrosurgical excision procedure(LEEP knife)and microwave on cervical erosion and study the nursing effects.Methods One hundred and fifty cases of cervical erosion patients from January to December 2013 in our hospital were selected and randomly divided into observation group and control group with 75 cases in each group.Patients in the observation group were treated with LEEP knife and the control group with microwave treatment.All patients were nursed conventionally.The operative time,blood loss and efficacy of two groups were analyzed.Result Patients in the observation group had less blood loss,shorter operation time and a better curative effect than the control group with statistical difference(all P<0.05).Conclusions Compared with microwave treatment,LEEP knife can effectively treat the cervical erosion.Preparation before operation,mental care and knowledge-related nursing are critical for the smooth manipulation of the operation.

At present,all parts of our country and the units are on their own to explore the ways and methods of public health physician training,and to develop a unified national public health standardized training system is particularly important.This study introduces the composition and practice of British public health specialist training and its access system,draws on the successful experience of this system and puts forward some suggestions such as paying attention to the cultivation of clinical basic knowledge,rationally using industry associations and societies and so on from the public health doctor training system,which provides the basis for promoting the establishment of a national public health physician training system.

Objective To investigate the effect of JUC on the incisions for episiotomy.Methods Three hundred primiparas to undergo episiotomy in our hospital were divided into two groups in equal number.The experiment group was given JUC Spray before suturing and the control group did not use any solution.In the two groups,antibiotics were not used after the operation,and the incisions were only cleaned with 0.5%povidone-iodine 2 times a day.Result There were significant differences between the two groups in terms of postoperative pains,inflammation and healing in the wounds,and hospital stay(P<0.05).Conclusions Application of JUC after episiotomy could be long-acting in antibacteria.It can reduce wound pain,improve wound healing rate, decrease the medical cost and shorten the hospital stay.

Objective To detect the changes of CD4 + CD25 + CD127low/-regulatory T (Treg) cells in peripheral blood in patients with portal hypertension and hepatitis B virus infection before and after splenectomy,and to study the effects of splenectomy on the immune function of patients with portal hypertension.Methods The clinical data of 20 patients with portal hypertension,hepatitis B virus infection and hypersplenism who were admitted to the Third Hospital of Hebei Medical University from May 2012 to May 2013 were retrospectively analyzed.The dynamic levels of CD4 + CD25 + CD127low/ Treg cells in the peripheral blood of the 20 patients (portal hypertension group) at 1 day before splenectomy and at postoperative week 1,month 1 and month 3 were detected by flow cytometry,and the dynamic levels of CD4 + CD25 + CD127low/ Treg cells in the peripheral blood of 10healthy individuals (control group) from the same hospital were also detected by flow cytometry.The effects of changes of Treg cells on the immune function were analyzed.All data were analyzed using the t test or repeated measures analysis of variance.Results The proportions of CD4 + CD25 + CD127low/-Treg cells before operation were 5.1％ ± 3.5％ in the portal hypertension group and 1.4％ ± 0.2％ in the control group,with significant difference between the 2 groups (t =2.573,P ＜ 0.05).The proportions of CD4 + CD25 + CD127low/ Treg cells in the portal hypertension group at postoperative week 1,month 1 and month 3 were 9.2％ ±2.7％,5.6％ ± 1.7％and 2.5％± 2.1％,respectively.There was significant difference in the proportion of CD4+ CD25 + CD127low/-Treg cells between postoperative week 1 and that before operation (F =9.814,P ＜ 0.05),while there was no significant difference in the proportion of CD4 + CD25 + CD127low/-Treg cells between postoperative month 3 and that before operation (F =2.364,P ＞ 0.05).Conclusion The proportion of Treg cells increases in a short period after splenectomy,and then it decreases as time passed by,which indicates that splenectomy has slight influence on the immune system from the perspective of Treg cells.

Objective To evaluate the surgical technique and the clinical effect of applying free superficial palmar branch of the radial artery flap to repair soft tissue defect of finger pulp.Methods From June,2011 to December,2013,12 cases of soft tissue defect of finger pulp and bone exposed were treated with free superficial palmar branch of the radial artery flap.The flap was designed from the proximal end of palmar wrist and the donor site was sutured directly.The size of the harvested flaps was between 2.5 cm × 1.0 cm and 6.2 cm × 3.8 cm,and the sensation of the flap was reconstructed via median nerve cutaneous branch.Results All transfering flaps survived and all cases were followed up for 4 to 17 months.The donor site got primary healing with a straight car.The appearance and texture of the flaps were satisfactory.2-point discrimination ranged from 6 to 11 mm.The pain sensation,warmth sensation and touch sensation of the flap got better.Conclusion The free superficial palmar branch of the radial artery flap is easy to harvest and anastomose,which is masked and a small incision for the donor site.The appearance and sensation of the flap which has sensory nerve branched for sensory reconstruction is satisfactory.It is an ideal method for the repairment of finger pulp defects.

BACKGROUND: Acute renal insufficiency (ARI) usually occurred following liver transplantation due to the surgical trauma and the application of immunosuppressant, which lack of unified diagnostic criteria. OBJECTIVE: To investigate the experience of diagnosis and treatment of ARI following liver transplantation.DESIGN, TIME AND SETTING: The experiment was performed at the 458 Hospital of Chinese PLA from January 2004 to December 2006.PARTICIPANTS: A total of 37 cases received liver transplantation, including 35 males and 2 females, aged 37-67 years, mean aged (48.5±8.9) years. All cases were divided into the liver cancer group (n=16) and liver cirrhosis group (n=21). The liver cirrhosis group included 16 cases with posthepatitic type B cirrhosis, 4 with posthepatitic type C cirrhosis, and 1 with alcoholic cirrhosis. All these cases were in decompensation stage. The final diagnosis was performed by pathological examination. METHODS: The removal of kidney and construction of blood outflow tract was achieved by modified piggy-back liver transplantation. The arterial blood gas analysis, blood routine examination, renal function and liver function were examined more than twice per day. The cephalosporins, Fluconazole and ganciclovir or vancomycin were used for 5-7 days to prevent infections.MAIN OUTCOME MEASURES: The incidence rate of acute ARI, clinical features and outcomes of patients were observed.RESULTS: ARI developed in 19 patients with liver transplantation, 5 patients died, 14 patients recovered in 2-3 weeks. The incidence of ARI following liver transplantation was associated with infection, bleeding shock, respiratory failure and acute respiratory distress syndrome (P < 0.05). CONCLUSION: The incidence of ARI following liver transplantation was 51.35%, with 26.32% mortality rate. The early diagnosis and treatment are the key steps for increasing successful rate of ARI treatment following liver transplantation.

Aim To investigated the possible effect of COX-2 on the BMP9-induced activation of PI3K/Akt signal in progenitor cells.Methods The activity of alkaline phosphatase(ALP) was measured using histochemical staining or chemiluminescence.The mRNA level of ALP was determined using real-time PCR assay.The protein levels of osteopontin(OPN), osteocalcin(OCN), COX-2, Akt1/2 and phosphorylated Akt1/2 were detected by Western blot.The mRNA level of COX-2 was assayed with RT-PCR, and the mineralization was measured with Alizarin Red staining.Results The ALP activity was apparently increased by BMP9 in C2C12 cells, as well as the protein level of OPN and OCN.The mineralization was also markedly induced by BMP9 in C2C12 cells.BMP9 increased the level of phosphorylated Akt1/2 greatly, although no substantial effect was observed on total protein level of Akt1/2.The BMP9-induced ALP activity was dramatically decreased by the inhibitor of PI3K.The mRNA and protein level of COX-2 were both increased by BMP9 in C2C12cells, and the BMP9-induced ALP activity and mineralization were greatly attenuated by the inhibitor of COX-2.The BMP9-induced phosphorylation level of Akt1/2 was increased by the exogenous expression of COX-2, but decreased by the inhibitor of COX-2.Conclusion Activation of PI3K/Akt signaling may be a critical event in BMP9-induced osteogenic differentiation, and this process may be mediated by the BMP9-upregulated COX-2 in stem cells at least.