Roles and functions of rural health midwives in Cordillera Administrative Region: A qualitative pilot study

Background@#Midwives have been frontline health professionals at the grassroots level, especially in rural communities. Their role was expanded from maternal and child healthcare providers to primary healthcare services providers. Despite their expanded functions, there have been limited studies investigating the professional practice of midwifery in the Philippines in a rural setting.@*Objective@#This study aimed to investigate the professional practice of midwives in selected rural areas in the Cordillera Administrative Region, Philippines.@*Methods@#This research is a qualitative pilot study using a semi-structured interview guide to collect the data. Key informant interviews were conducted through mobile phone calls convenient for the participants from September to October 2021. Data were analyzed through qualitative content analysis.@*Results@#A total of seven rural health midwives participated in this study. From the data analysis, six themes emerged related to the professional functions of rural Filipino midwives: 1) antenatal and postnatal care, 2) basic emergency obstetrical and newborn care, 3) health education and counseling, 4) treating common children and adult infections, 5) health promotion, and 6) beyond midwifery role.@*Conclusion@#Rural midwives play a role in providing several primary healthcare services mandated by the government and the profession. They also offer health services beyond their scope as midwives because of geographical difficulties and logistic issues. The findings inform the policymaker to review and amend the expanded roles of practicing midwives so that they will be empowered in providing quality and legal healthcare services. The study results will also be important in preparing midwives for rural midwifery practice.

SingHealth Radiology Archives pictorial essay Part 2: gastroenterology, musculoskeletal, and obstetrics and gynaecology cases

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in commemoration of the International Day of Radiology in 2020, as well as the 200th anniversary of the Singapore General Hospital in 2021. This pictorial essay comprises gastroenterology, musculoskeletal and obstetrics and gynaecology cases from the archives.

Research progress in osteogenic differentiation of bone marrow mesenchymal stem cells in steroid-induced osteonecrosis of the femoral head / 解放军医学杂志

Steroid-induced osteonecrosis of the femoral head (SONFH) is a kind of disease caused by hip joint dysfunction. Long-term or high-dose application of hormone drugs leads to impaired blood supply to the femoral head and the death of a variety of bone stromal cells, resulting in the structural change of trabecular bone in the load-bearing area of the femoral head and irreversible collapse of the femoral head. Early manifestations were hip pain and discomfort, and tenderness in the inguinal region, in the middle stage, pain affects activity; in the later stage, the hip joint space become narrowed, the motion of the hip joint is reduced, and the motion is limited. SONFH has greatly affected the quality of life of patients, so modern medicine is dedicated to improve the symptoms of patients through early intervention, enabling SONFH to get effective treatment and reducing the pressure of life and economic burden of patients. Bone marrow mesenchymal stem cells (BMSCs) have become a focus in the early treatment of SONFH due to its osteogenic differentiation. BMSCs are stem cells with multi-directional differentiation potential, with self-proliferation and differentiation characteristics, which can differentiate into bone, provide mechanical support for the necrotic area and secrete a variety of growth factors to support hematopoiesis, slow down the progress of disease, and extend the service life of their own joints. The unreasonable use of hormones mainly inhibits the osteogenic activity of BMSCs, resulting in the occurrence of SONFH. This paper reviews the research on BMSC osteogenic differentiation in recent years, hoping to improve the therapeutic effect of SONFH.

Trend of fall mortality among the elderly in Hangzhou from 2006 to 2018 / 预防医学

Objective@#To analyze the status and trend of fall mortality among the elderly from 2006 to 2018 in Hangzhou, and to provide basis for fall prevention and control. @*Methods@#Through the medical certificate of death in hospitals at the county level and above and community health service centers, the monitoring data of the deaths from fall among the elderly aged 60 years and above in Hangzhou from 2006 to 2018 were collected. The crude motality rate, standardized mortality rate of fall and the annual percentage change ( APC ) were calculated to examine the status and trend of fall mortality in different gender, age and areas. @*Results@#The crude mortality rate of fall among the elderly in Hangzhou was 85.60/100 000 and the standardized mortality rate was 71.42/100 000 from 2006 to 2018. The crude and standardized mortality rate from 2006 to 2018 showed increasing trends and the APCs were 3.46% and 2.33%, respectively ( P<0.05) . The crude mortality rate was 93.01/100 000 in females, which was higher than 77.82/100 000 in males ( P<0.05 ) , the APCs were 3.25% and 3.77%, respectively. The crude mortality rate of rural areas was 129.03/100 000, which was significantly higher than 60.73/100 000 of urban areas ( P<0.05 ) . The mortality rate of urban and rural areas showed increasing trends, the APCs were 5.02% and 2.43%, respectively. The crude mortality rate of fall among the elderly in Hangzhou increased gradually with age ( P<0.05 ) . @*Conclusion@#The fall mortality among the elderly in Hangzhou increased from 2006 to 2018. More efforts are needed to reduce fall mortality in females and rural population.

SingHealth Radiology Archives pictorial essay Part 1: cardiovascular, respiratory and neurological cases

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in 2020 in commemoration of the 20th anniversary of the formation of SingHealth, the 55th National Day of Singapore, and the 125th anniversary of the International Day of Radiology. This pictorial essay comprises cardiovascular, respiratory and neurological cases from the archives.

Risk factors of underestimating diagnosis with ductal carcinoma in situ following core needle biopsy / 复旦学报（医学版）

Objective To analyze the risk factors of underestimation from core needle biopsy (CNB) diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision.Methods One hundred and fifteen cases of CNB diagnosed DCIS treated in Obstetrics and Gynecology Hospital,Fudan University from Jan.,2010 to Dec.,2016 were analyzed retrospectively.According to postoperative pathological conditions,the cases were divided into underestimation group and non underestimation group.The clinicopathological characteristics of two groups were compared,including age,palpability,tumor diameter,microcalcification,BI-RADS classification and CNB method.Results The overall underestimating rate was 27.0％ (31/115).Univariate analysis found correlation between a palpable lesion,diameter of tumor ＞20 mm,microcalcification,a high BI-RADS classification,use of the 14/16-gauge needle method and underestimation from CNB diagnosed DCIS.Multivariate analysis by Logistic regression showed that diameter of tumor ＞20 mm (OR =0.186,95％CI:0.043-0.810,P =0.025),microcalcification (OR=0.229,95％CI:0.070-0.749,P =0.015),use of the 14/16 gauge needle method (OR =0.171,95 ％ CI:0.043-0.679,P =0.012) were independent risk factors of underestimation from CNB diagnosed DCIS.Conclusions Size of lesion ＞20 mm,microcalcification,use of the 14/16-gauge needle method were independent risk factors of underestimation from CNB diagnosed DCIS.

Application of OCT in traumatic macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To observe the application of optical coherence tomography ( OCT ) in the diseases of traumatic macular hole.·METHODS: Twenty - five eyes of 23 patients with traumatic macular hole from January 2015 to January 2017 were enrolled in this study, including 9 eyes treated without surgeries, 16 eyes with surgeries. The image features were analyzed using OCT from ZEISS.·RESULTS: The OCT characteristics in patients with traumatic macular hole were partial or full - thickness disappearance of the neuro-epithelium. Posterior vitreous detachment was not seen in the traumatic macular hole. OCT examination revealed that 4 eyes had partial detachment of macular hole and 21 eyes had full thickness detachment. Of the twenty-one eyes, 4 eyes had simple macular hole, 10 eyes had macular full-layer division with peripheral nerve epithelium edema, 7 eyes had the macular full - layer hole with the neuro - epithelium localized detachment. In the 25 eyes, 9 eyes did not undergo the surgery, of which 7 eyes were self-healing;16 eyes were surgically treated. Postoperative OCT showed the macular structure were normal in 12 eyes with the visual acuity improved 3 lines; retinal nerve epithelium were thinning in 4 eyes, visual acuities were not significant improved after surgery.·CONCLUSION: OCT examination is necessary for the diagnosis and treatment of traumatic macular hole.

Postoperative Low Absolute Lymphocyte Counts may Predict Poor Outcomes of Hepatocellular Carcinoma After Liver Resection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The absolute lymphocyte counts (ALCs) have been reported as one of worse prognostic factors for hepatocellular carcinoma (HCC) patient after liver transplantation. The aim of this study was to assess the influence of ALCs on the outcomes of patients with hepatitis B virus (HBV)-related HCC within the Milan criteria following liver resection.</p><p><b>METHODS</b>Data of patients with HCC within the Milan criteria who received liver resection between January 2007 and June 2013 were reviewed, and perioperative ALCs were carefully monitored. All potential risk factors were statistically analyzed by uni- and multi-variate analyses. The receiver operating characteristic (ROC) curve was used to determine the optimal ALCs cut-off value to predict HCC recurrence after liver resection.</p><p><b>RESULTS</b>A total of 221 patients were enrolled in the current study. During the follow-up period, 106 patients experienced recurrence, and 38 patients died. Multivariate analysis suggested microvascular invasion (MVI), a tumor grade ≥2, and a low postoperative ALCs in the 1st postoperative month increased the incidence of postoperative recurrence, besides, MVI, intraoperative transfusion, and a low postoperative ALCs in the 1st postoperative month were associated with poor overall survival (OS). An ROC analysis showed that a cut-off value of 1.5 × 109/L for ALCs in the 1st postoperative month predicted postoperative recurrence. The 5-year recurrence-free survival (RFS) and OS rates of patients with low postoperative ALCs were 34.5% and 64.8%, respectively, which were significantly lower than those of patients with high postoperative ALC (58.5% for RFS and 86.5% for OS).</p><p><b>CONCLUSION</b>Low ALCs in the 1st postoperative month may be associated with high recurrence incidence and poor OS for patients with HBV-related HCC within the Milan criteria after liver resection.</p>

The dynamic expression changes of myocardium p-p38MAPK, NF-κB and COX-2 in rats after an exhausted exercise / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To observe the dynamic expression changes of p38 mitogen-activated protein kinase (p38MAPK), nucler facter kappa B (NF-κB) and cyclooxygenase-2 (COX-2) in myocardial tissue after an exhausted exercise and study the impact of p38MAPK, NF-κB and COX-2 on its myocardial damage.</p><p><b>METHODS</b>Sixty Wister male rats were randomly divided into the control group (n = 10) and the exhausted exercise group (n = 50). Then the exhausted exercise group was further divided into 5 subgroups, namely 0 h, 3 h, 6 h, 12 h, 24 h after an exhausted exercise (n = 10). The myocardial injury animal model was set up by using an exhausted swimming exercise and the expression of p-p38MAPK, NF-κB and COX-2 were examined by Western blot.</p><p><b>RESULTS</b>Compared with the control group, the expression of p-p38MAPK were increased significantly (P < 0.01) in all the groups and the 3 h group was the highest( P < 0.01); The expression of NF-κB were increased significantly (P < 0.05) in all the groups but 0 h P > 0.05) and the 6h group was increased significantly compared with the other groups( P < 0.05); The expression of COX-2 were increased significantly( P < 0.05) in all the groups but 0 h and the 24 h groups was increased significantly compared with the other groups(P < 0.05).</p><p><b>CONCLUSION</b>p38MAPK was activated in an acute exhausted exercise, p-p38MAPK may play an important role in modulating NF-κB and COX-2 expression and mediating the exhausted exercise induced myocardial damage.</p>

Risk factors for the development of acute respiratory distress syndrome in children with measles / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the risk factors for the development of acute respiratory distress syndrome (ARDS) in children with measles.</p><p><b>METHODS</b>The clinical data of 55 children with measles were retrospectively studied. Of the 55 children, 11 were complicated by ARDS. The risk factors for the development of ARDS were investigated by univariate analysis and multivariate non-conditional logistic regression analysis.</p><p><b>RESULTS</b>The univariate analysis showed that there were significant differences in the oxygen inhalation mode (nasal catheter/mask), the rate of sepsis, blood C-reactive protein (CRP) levels and lymphocyte counts at admission between the ARDS and non-ARDS groups (P<0.05). The presence of sepsis and higher blood CRP levels were identified as the major risk factors for the development of ARDS by the multivariate logistic regression analysis (OR=116.444, 1.050 respectively; P<0.05).</p><p><b>CONCLUSIONS</b>The children with measles who have sepsis and higher blood CRP levels are at risk of ARDS.</p>

Analysis of poor vision conditions and risk factors of myopia in primary school He'xi district of Sanya / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the poor vision condition and analyze the myopia etiological factor in primary school He'xi district of Sanya. METHODS: A cohort of 1 218 subjects were recruited randomly from grade 1~6 of two primary schools. Visual activity test, dioptroscopy and risk factor questionnaire were evaluated. RESULTS: The prevalence of poor vision was 29. 55%. The incidence of myopia increased with grade, and was significantly higher in girls than that in boys. The outdoor activity time of myopic pupil ( 7. 25 ± 5. 35h/wk ) was significantly lower than emmetropic pupil (11. 86±6. 65h/wk) ( P CONCLUSION: The increase of myopia incidence is closely related with sparing outdoor activity and excess usage of electronic product.

Can living donor liver transplantation offer similar outcomes to deceased donor liver transplantation using expanded selection criteria for hepatocellular carcinoma?

To compare the outcomes of living donor liver transplantation [LDLT] versus deceased donor liver transplantation [DDLT] for patients with hepatocellular carcinoma [HCC] in different selection criteria. Data of patients with HCC who underwent liver transplantation between 2005 and 2013 at our center were reviewed. Clinical data of LDLT recipients and DDLT recipients were compared. The postoperative recurrence-free survival [RFS] rate and overall survival [OS] rate after LDLT versus DDLT were compared in the Milan recipients, the University of California, San Francisco [UCSF] recipients, the up-to-seven recipients, the Hangzhou recipients and the Chengdu recipients. Data of 255 patients were retrospectively reviewed in this study. Seventeen DDLT recipient and 9 LDLT recipients died during the perioperative period. Among the remaining 229 recipients [N[LDLT]=66, N[DDL]T=163], 96 patients met the Milan criteria, 123 recipients met the UCSF criteria, 135 patients met the up-to-seven criteria, 216 patients met the Hangzhou criteria, and 229 recipients met the Chengdu criteria. The overall RFS and OS rates of the Milan recipients, the UCSF recipients, the up-to-seven recipients, the Hangzhou recipients and the Chengdu recipients after LDLT and DDLT were all similar. Using well-studied selection criteria, LDLT offers similar outcomes to DDLT for patient with HCC, even using expanded selection criteria

Short-term prognostic factors in children with acute liver failure / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the factors that influence the short-term (6 months) prognosis in children with acute liver failure.</p><p><b>METHODS</b>The clinical information of 53 children with acute liver failure treated between June 2008 and September 2013 was retrospectively analyzed. The patients were divided into survival group (n=21) and death group (n=32) according to their outcomes. The liver function parameters and incidence of complications were compared between the two groups, and multivariate logistic regression analysis was used to identify major factors affecting the short-term prognosis in these patients.</p><p><b>RESULTS</b>There were significant differences between the death and survival groups in the indices of international normalized ratio (INR), blood ammonia and serum albumin (Alb), and complications such as hepatic encephalopathy, gastrointestinal hemorrhage, and multiple organ failure (P<0.05). Multivariate logistic regression analysis demonstrated that serum Alb, INR, and hepatic encephalopathy were the major factors affecting the short-term prognosis of acute liver failure (OR=0.616, 75.493 and 1210.727 respectively; P<0.05).</p><p><b>CONCLUSIONS</b>INR, hepatic encephalopathy and serum Alb are the major factors that influence the short-term prognosis in children with acute liver failure.</p>

Two sets of acupoint combination of similar functions engage shared neural representation: a functional magnetic resonance imaging study / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate whether the neural representations underlying alternating two acupoint combinations (ACs) are the same or not.</p><p><b>METHODS</b>In this functional magnetic resonance imaging study, two sets of analgesia ACs were utilized, including Waiguan (TE5) and Qiuxu (GB40) for Group A, and Neiguan (PC6) and Taichong (LR3) for Group B, which are the most commonly adopted in clinical treatment. Each group had 20 healthy subjects. An experimental design was proposed, which consisted of a pre-needling resting phase, a needling phase and a post-needling resting phase. This paradigm optimally mimics the clinical protocol as well as focuses on both the stimulation and the resting periods. The results were subjected to general linear model analysis, conjunction analysis and the functional connectivity analysis.</p><p><b>RESULTS</b>The rostral anterior cingulated cortex was engaged in the initiative period of the acupuncture effect in both groups, and it was chosen as the seed region for the functional connectivity analysis for the following resting period. The results showed that several shared brain regions were involved in both groups, in particular the insula, amygdala and hypothalamus. Moreover, significant differences were located at the posterior cingulated cortex as revealed by a two sample -test (P<0.05, corrected). Other regions showed no significant differences. This finding was further supported by the spatial correlation analysis that the two groups were significantly correlated (r =0.51, P<0.01).</p><p><b>CONCLUSION</b>This preliminary research helps us understand the neurophysiological mechanisms of acupuncture when following clinical guidelines on ACs, as well as provides an important opportunity to develop better treatment strategies for reducing, or even preventing pain.</p>

Characteristics of circulatory disturbance and the treatment of severe hand-foot-and-mouth disease / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of circulatory disturbance and treatment of severe hand-foot-and-mouth disease (HFMD).</p><p><b>METHOD</b>The clinical characteristics, laboratory findings, therapy and outcome of 22 severe HFMD patients were retrospectively analyzed.</p><p><b>RESULT</b>All the 22 severe HFMD patients came from the countryside. All these patients had encephalitis. Fifteen cases had myocardial injury. All had symptoms of sympathetic excitation and 17 cases had hypertension [(128 ± 16)/(81 ± 14) mm Hg (1 mm Hg = 0.133 kPa)]. Fourteen cases had exacerbation with rapid decline of blood pressure [(61 ± 12)/(33 ± 12) mm Hg]. In cardiorespiratory failure stage, 13 patients had neurogenic pulmonary edema accompanied by circulatory failure and 12 cases had a lower glasgow scores (less than 7). Myocardial injury and ECG change were found in some cases. Inotropic and pressor drugs were given in patients with circulatory collapse. Five cases received fluid resuscitation due to refractoriness to inotropic drugs. Nine patients received blood purification. Seventeen survived and 5 cases died due to circulatory failure.</p><p><b>CONCLUSION</b>Circulation failure of severe HFMD is the main cause of death. Early and appropriate circulation support is very important to reduce mortality.</p>

Mild cognitive impairment disease treated with electroacupuncture: a multi-center randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To verify the clinical efficacy on mild cognitive impairment (MCI) treated with electroacupuncture (EA) intervention based on the principle as "promoting the circulation of the Governor Vessel and regulating the marrow" and plan to provide the A-grade evidence of the evidence-based medicine for the clinical treatment of this disease with acupuncture and moxibustion.</p><p><b>METHODS</b>The multi-center randomized controlled trial (RCT) was adopted. One hundred and ninety-two cases of MCI were randomized into an EA group and a nimodipine group, 96 cases in each one. In the EA group, EA was applied to Shenting (GV 24), Baihui (GV 20), Sishen cong (EX-HN 1) and Fengchi (GB 20), once every other day. In the nimodipine group, Nimodipine was pre scribed for oral administration. Four weeks constituted one course, the treatment of 8 weeks was required. The minimum mental state examination (MMSE) and the graphic recognition test (GRT) were applied before and in the 1st and 2nd session of treatment separately. The follow-up visit of MMSE scale was provided in the 1st, 3rd and 6th months after treatment separately.</p><p><b>RESULTS</b>The total effective rate was 50.0% (47/94) in the EA group, which was superior to 34.4% (32/93) in the nimodipine group (P < 0.05). At the end of the 1st session treatment, the differences in MMSE total score and the cognitive, memory and speech dimensional scores were not significant statistically between two groups (all P > 0.05). At the end of the 2nd session treatment, the MMSE total score and the cognitive, memory, visual-space skill dimensional scores were improved in comparison before treatment (all P < 0.05). The results in the EA group were superior to those in the nimodipine group (all P < 0.05). But the difference in the speech dimensional score was not significant statistically between the two groups (P > 0.05). In the EA group, the GRT score was improved significantly after 2 sessions of treatment as compared with that before treatment (P < 0.01) and was superior to that in the nimodipine group (P < 0.05). In the 1st, 3rd and 6th month after treatment, the MMSE scale total scores were different significantly in statistics between the two groups (all P < 0.01). The long-term efficacy in the EA group was superior to that in the nimodipine group.</p><p><b>CONCLUSION</b>Both of the EA therapy based on the principle as "promoting the circulation of the Governor Vessel and regulating the marrow" and the nimodipine program improve significantly the cognitive function of MCI patients. Compared with the nimodipine program, the EA therapy improves the comprehensive cognitive and the short-term memory abilities much more significantly and is especially advantageous at improving cognitive, memory and visual-space skill dimensions for MCI patients. In the half a year follow-up visit after the end of treatment, the long-term efficacy of EA is better than that of Nimodipine.</p>

The dynamic change of serum CK, CK-MB and myocardium histomorphology after exhausted exercise in rats / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To study the dynamic changes of serum CK, CK-MB and myocardium histomorphology in different time periods after single bout and repeated exhausted exercise in rats.</p><p><b>METHODS</b>The animal models of myocardial injury were established by exhausted swimming. Creatine kinase (CK), creatine kinase mass (CK-MB) activities in serum were measured immediately at 3, 6, 12, 24, 48 and 96 hours after exhausted exercise, and the dynamic changes of myocardial histopathology were examined.</p><p><b>RESULTS</b>The CK, CK-MB activities were significantly increased immediately at 3, 6, 12 hours and peaked at 6 hours after single bout of exhausted exercise, meantime the degree of inflammatory cell infiltrate and strong acidophil staining were gradually increased in myocardium of rat, and the myocardial injury was most severe at 12 hours. After 1-week consecutive daily exhausted swimming, CK, CK-MB in serum were obviously increased immediately at, 3, 6, 12, 48 and 96 hours postexercise and peaked immediately and at 96 hours respectively postexercise. There were different degrees of myocardial injury in different time of recovery phase, and was most severe at 48 hours postexercise.</p><p><b>CONCLUSION</b>The myocardial injury was induced by excessive exercise and/or exhausted exercise, and the resulting delayed-onset myocardial injury was further certified.</p>

Response surface methodology used for statistical optimization of jiean-peptide production by Bacillus subtilis cells adsorbed on wood chips

Response surface methodology (RSM) was used for statistical optimization of jiean-peptide (JAA) production by Bacillus subtilis ZK8 cells adsorbed on wood chips to form a novel fermentation system. The Plackett-Burman design was used in the first step to evaluate the effects of eight factors, including six fermentation medium components and two cell adsorption conditions. Among the variables screened, soybean meal hydrolysate (SMH) and MgSO4A7H2O in the fermentation medium had significant effects on JAA production. In the second step, the concentrations of SMH and MgSO4A7H2O were further optimized using central composite designs and response surface analysis. The optimized concentration of SMH and MgSO4À7H2O was 24 percent (v/v) and 0.38 percent (w/v), respectively, which increased the production of JAA in a shake flask system by 41 percent relative to optimization of a single variable component of the culture medium.

Drug release properties of sodium alginate hydrophobically modified by star polylactic acid / 药学学报

Inorganic/polymer hybrid star polylactic acid (POSS-PLA) was obtained through ring-opening polymerization of lactide by using polyhydroxyl cage silsesquioxane (POSS-OH) as the core and tin (II) octoate as the catalyst. The star polylactic acid (POSS-PLA) was used to modify sodium alginate hydrophobically and a drug carrier was obtained. The drug release behavior was investigated by using ibuprofen as the model drug. The results showed that the drug loading rate could be improved and the release rate was postponed with an increase of POSS-PLA content in the carries. The release mechanism gradually changed from the first-order to the zero-order pattern after the modification.

Transdiaphragmatic exposure for direct atrioatrial anastomosis in liver transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.</p><p><b>METHODS</b>Nine patients (six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis) underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.</p><p><b>RESULTS</b>All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.</p><p><b>CONCLUSIONS</b>Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graft replacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.</p>