Primary biliary cirrhosis(PBC) is a chronic,progressive cholestatic liver disease of unknown cause that usually affects middle-aged women.Ursodeoxycholic acid(UDCA)is the first selected drug to PBC which has definite effect.Treament of PBC with UDCA combined with immunodepressant become presents research focuses.Liver transplantation is the only treatment of the final stage of PBC.

Objective To describe the clinical features of patients with hemorrhagic fever with renal syndrome (HFRS) in popular period and other period.Methods All the HFRS patients from epidemic areas in Xi' an were surveyed retrospectively.The sociodemographic data,symptom characteristics and laboratory test results were collected.Chi-square test,rank test were used to analyze the data.Results Totally 429 HFRS cases were recruited including 280 male (65.3％) and the male/female ratio was 1.9 ∶ 1.Adults with 16-60 years of age were the main group,which accounted for 74.8％ of the total cases.The constituent ratios of cases with 16-60 years of age in popular period and other period were 76.1％ (245/322) and 71.0％ (76/107),respectively; the sex ratios were 1.93∶1 and 1.74∶1,respectively; the time from fever onset to hospitalization was 3 d and 4 d,respectively; the time of hospitalization was both 10 d; the proportions of emergency cases were 59.8％ (189/316) and 67.6％ (71/105),respectively; the proportions of cured cases were 56.4％ (181/321) and 43.4％ (46/106),respectively.The clinical features were not significantly different between popular period and other period (all P＞0.05).The immunoglobulin M (IgM) antibody positive rate was 85.4％ (315/369) and those in popular period and other period were 88.4％ (251/ 284) and 75.3％ (64/85),respectively (x2 =8.968,P＜0.01).There was a positive correlation between symptom severity and outcome of discharge (x2=18.558,P＜ 0.01),the more slight symptoms were related with the better outcome.Conclusion The clinical features are similar in cases from popular period and other period from Jan 2008 to Jun 2011.

ObjectiveTo compare the clinical results of small surgical incision of bilateral spinous process and traditional open surgical incision in posterior single level lumbar interbody fusion,and assess the application value of the small surgical incision of bilateral spinous process in posterior single level lumbar interbody fusion.MethodsFrom December 2006 to June 2008,70 patients with lower lumbar vertebral diseases underwent single segment posterior lumbar interbody fusion.Patients were randomly divided into small surgical incision of bilateral spinous process group(Hereinafter referred to as small incision group) of 36 cases and 34 cases of conventional open group.Small incision group included 20 males and 16 females with an average age of 52.0 years.Traditional open group included 16 males and 18 females with an average age of 53.2 years.Two groups of operative time,blood loss,postoperative drainage,X-ray projection operation frequency,hospital stay,complication rate,creatine phosphokinase (CPK) level,multifidus cross-sectional area,postoperative low back pain visual analogue scale(VAS),Oswestry disability index(ODI),interbody fusion rate were compared,respectively.ResultsAll of 70 cases were followed up for 12-24 months (average,16).There were no statistically differences in the operation time,the number of X-ray projection,complication rate,and fusion rate between the two groups (P＞0.05),but there were significant differences in blood loss,postoperative drainage,the first day and the third day of postoperative the level of CPK,postoperative multifidus muscle cross-sectional area,postoperative low back pain VAS,hospital stay,and postoperative ODI between the two groups(P＜0.05).ConclusionSmall surgical incision of bilateral spinous process and traditional open surgical posterior lumbar interbody fusion were satisfied with the efficacy,but small surgical incision of bilateral spinous process with less trauma,shorter hospital stay,and rapid postoperative recovery.

Objective To investigate the influence of Zhuanggu granule on the concentration of IL-1β and TN-F-α in knee cavity of patients with knee degenerated osteoarthritis. Methods A total of eighty patients with knee degenerated osteoarthritis were recruited into a Zhuanggu granule group (30 cases), a Sulphuric acid Glucosamine group (15 cases) and a Sodium Hyaluronate group (15 cases) according to Doll grouping method. After all groups were treated for 4 weeks, the changes of concentration of IL-1β and TNF-α was detected before and after the therapy Results After the treatment, the concentration of IL-1β and TNF-α in Zhuangu granule group was significantly lower than the other two groups (Sodium Hyaluronate and sulphuric Glucosamine group). Conclusion Zhuangu Granule could influence the concentration of IL-1β and TNF-α in patients of knee degenerated osteoarthritis.

Macrophages,as an important member of innate immune system,constitute a major component of the microenvironment of tumours,and play an important role in the occurrence and development of tumor.According to particular phenotypes and functions,macrophages can be divided into M1 macrophages and M2 macrophages.In the research of breast cancer,lung cancer,gynecological malignancies,researchers have found that tumor-associated macrophage has the similar phenotype and function of M2 macrophages.Tumor-associated macrophage can promote the formation of new blood vessels and lymphatic vessels in tumor tissue,thus contributing to the occurrence and development of tumor.The relation between tumor-associated macrophage and poor prognosis was also be found.The tumor microenvironment can affect the phenotype and function of macrophages,such as TGF,IL-10 and PGE-2.This paper reviewed the role and mechanism of macrophages in the tumorigenesis.

Objective To study the protein levels of fibronectin (Fn) in the sinoatrial node tissues of hearts caused by electric shock death ,and to provide a new theoretical basis for the diagnosis of electric shock death and the identification of death time.MethodsUsing immunohistochemical technique(S-P method) to detect protein levels of 15 cases of human sinoatrial node following electrocution(human experimental group),15 cases of human sinoatrial node with severe traumatic cerebral injury(human control group),35 cases of rabbit sinoatrial node following electrocution(rabbit experimental group ,divided into7 groups according to different sampling time: 0 h ,1 h ,3 h ,6 h ,12 h,24 h.48 h),and 35 cases of rabbit sinoatrial node with broken neck executed(rabbit control group ,divided int0 7 groups according to different sampling time :0 h,1 h.3 h,6 h.12 h.24 h,48 h).ResultsFn positive expression rate in human experimental group was 100% while it was 6.67% in the human control group,and the differences were statistically significant (P < 0.01 ).The Fn expression can be seen after electric shock immediately in the rabbit experimental group,and there was statistical difference compared with the rabbit control group (P < 0.05).Distribution of Fn expression became more and more widely after 3 hours t0 12 hours in the rabbit experimental group ,and there was significant difference compared with the rabbit control group(P < 0.01).The Fn expression began to decrease 24 hours after electrocution,ancl it still had statistical significance 48 hours after electrocution compared with the rabbit control group (P < 0.05).Conclusion Electric shocks significantly enhanced the expression of Fn protein levels in the sinoatrial node tissues , and optical density of Fn positive expression has a regularity change along with the extended time of death.These results could provide a theoretical reference basis for forensic diagnosis of electrocution and identification of death time.

Objective To describe the vaccine inoculation rate of hemorrhagic fever with renal syndrome (HFRS) and the movement characteristics of rural population in the Xi'an epidemic area.Methods This was a cross-sectional study.The study covered all the four HFRS traditional high incidence areas (counties):Zhouzhi,Huxian,Chang'an and Lintong.Three villages were selected in each county and 20 households were selected in each village in 2013.Participants included all the persons of these families.People 16-60 years old were interviewed face to face about their sociodemographic and environmental information,and at the same time related HFRS vaccine history and characters of migrant workers were collected.Results Nine hundred and ninety-six persons were investigated,69.3 percent (690/996) were vaccinate-age population.Of all,49.0 percent (338/690) had HFRS vaccine history and 53.9 percent (372/690) had worked away from home most of the year.The inoculation proportion of workers which worked in their own counties (56.8％,67/118) were higher than that of workers worked outside (37.0％,60/162;39.1％,36/92,x2 =10.74,6.44,all P ＜ 0.017).In the workers that went back home every week,60.3 percent (76/126) had vaccinated.Workers that went back home once a year had the lowest proportion of inoculation (16.7％,7/42).The morbidity of HFRS decreased significantly accompany with ascend of inoculation rate (Y =-0.524X + 38.319,t =-4.581,P ＜ 0.05).Conclusions After the free vaccinations,there is still a gap between the vaccine inoculation rate and prevention benefit.The current vaccination strategies need to be adjusted.

Objective To study the developmental patterns and aging characteristics of anterior sacral foramina and posterior sacral forami-na in adolescents aging from 12 to 18 years old through CT imaging scanning and three-dimensional reconstruction measurement,and to provide the anatomical basis for the diagnosis and treatment of sacral vertebra diseases.Methods The 30 adolescents without any the problems of nerv-ous system were selected to conduct 64-slice spiral CT in the pelvic cavity.The original data were input into three-dimensional reconstruction software Mimics with the form of DICOM,and the relevant indicators were measured and analyzed.Results There was no significant difference in the height,width and distance of inner edge of anterior sacral foramina and the posterior sacral foramina in different gender and sides (P >0.05).The physical development of human increases gradually with age and there were significant differences.Conclusion There is a regular change process in the relevant indicators of anterior sacral foramina and posterior sacral foramina in adolescents.But the clinical appli-cation must be combined with the results of individual imaging,the technology of reverse engineering and the support of rapid prototype manu-facturing so as to meet the satisfactory results of individualized treatment.

Objective To explore effect of transforaminal interbody fusion (TIF) in the treatment of thoracolumbar fracture.Methods From January 2009 to June 2010,11 patients with thoracolumbar fracture underwent TIF in our hospital.There were 7 males and 4 females,aged from 22 to 54 years (average,37.8±9.5 years).Fracture occurred at T11,12 in 2 cases,T12L1 in 5 cases,L1,2 in 2 cases,L2,3 in 1 case,and L3,4 in 1 case.According to AO classification,all 11 cases were rated as type B.The thoracolumbar injury classification and severity score (TLICS) ranged from 7 to 10 (average,9.2±0.87).According to Frankel grading system,there were 3 cases of grade B,4 cases of grade C,3 cases of grade D,and 1 case of grade E.The operative time,blood loss,and complications were evaluated.Functional recovery was evaluated by Frankel grading system.Radiographic results were obtained before surgery and during follow-up,and Cobb angle was measured.Results The operative time ranged from 130 to 170 minutes (average,147.3±11.9 minutes).The blood loss ranged from 180 to 650 ml (average,369.1±110.2 ml).All patients were followed up for 13 to 26 months (average,20.2±4.3 months).There was no complication during operation and follow-up.X-rays at final follow-up showed that there was no internal fixation failure such as screws break and cages shift.The improvement in Frankel grade was observed in 9 cases.The average Cobb angle improved from preoperative -10.3°±7.8° (range,-21.2° to 3.2°) to 1.2°±7.4° (range,-7.9° to 17.2°) at final follow-up.Conclusion The TIF is an effective method for treating thoracolumbar fracture,which shows good results in deformity correction,improvement of neurological function,bone fusion and stability of internal fixation.

Objective To investigate the efficacy and safety of anterior approach using an expandable artificial vertebral body for the correction of post-traumatic kyphosis (PTK) in the thoracolumbar spine.Methods From August 2009 to August 2011,13 patients with PTK in the thoracolumbar spine were treated through an anterior approach using an expandable artificial vertebral body.There were 4 males and 9 females,aged from 38 to 62 years (average,53.3±7.6 years).The injury levels consisted of T12 in 5 cases,L1 in 6 cases and L2 in 2 cases.All the operations were done by a single surgeon group.In the procedure,symptomatic vertebra and its two discs were excised,and the bony endplates were reserved.After putting an expandable artificial vertebral body into the space,the kyphosis was corrected by extending the artificial vertebral body.The operative duration,blood loss,Cobb angle,visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded.Results All patients were successfully followed up for an average time of (18±5.5) months (range,12 to 28 months).The average Cobb angle was 33.9°±7.2°(range,22°to 53°)before operation and 7.3°±4.8°(range,2°to 16°)at final follow-up.The average VAS score was 6.4±0.9 (range,5 to 8)before operation and 1.5±0.8(range,0 to 3)at final follow-up.The average ODI was 50.5％±10.8％(range,38％ to 78％)before operation and 10.9％±4.9％(range,4％ to 22％) at final follow-up.All patients achieved bony fusion 12 months after operation.Conclusion Application of expandable artificial vertebral body through an anterior approach for PTK in the thoracolumbar spine has several advantages: large angle correction,less interruption of nerve,mini-invasion and less levels fixation.Satisfactory clinical outcome can be achieved.