Association between intrahepatic bile duct alterations and liver fibrosis / 临床肝胆病杂志

Liver cirrhosis is a liver disease caused by various factors and is characterized by diffuse fibrous hyperplasia, lobular structural damage, and pseudolobule formation. Bile duct proliferation has been observed in a variety of animal models of liver cirrhosis and patients with liver cirrhosis caused by different etiologies, and it is regulated by signaling pathways with the involvement of multiple regulatory factors such as neuropeptides, neurotransmitters, and hormones. Moreover, the proliferated bile ducts promote the formation of liver fibrosis by mediating the proliferation and activation of hepatic stellate cells. This article summarizes the changes of the intrahepatic bile duct system in liver cirrhosis and its influence on the process of liver fibrosis, various signaling pathways associated with cholangiocyte proliferation and liver fibrosis, and the value of the dynamic evolution of bile duct structure in predicting the degree of liver fibrosis. It is pointed out that bile duct proliferation may become a potential target for the intervention of liver fibrosis, which provides new ideas and methods for early treatment and reversal of liver fibrosis.

Comparison of effects of conservative treatment and percutaneous kyphoplasty on paravertebral muscle degeneration in patients with osteoporotic compression vertebral fractures / 中华骨科杂志

Objective:To compare effects of conservative treatment and percutaneous kyphoplasty on paravertebral muscle degeneration in patients with osteoporotic compression vertebral fractures.Methods:A retrospective case control analysis was conducted on 286 cases of osteoporotic compression vertebral fractures from January 2017 to December 2019. There were 54 males and 232 females, with a mean age of 67.7 (range, 52-90 years). According to the treatment, the patients were divided in to conservative treatment group (134 patients) and percutaneous kyphoplasty treatment group (152 patients). The pre-operation and post-operation of paravertebral muscle cross-sectional area (CSA) and fatty infiltration (FI% ) , bed rest time, visual analogue scale (VAS), Oswestry disability index (ODI), the sagittal view Cobb angle, and the anterior column height of fractured vertebra were compared between these two groups.Results:The two groups had no significant difference in CSA and FI% of paravertebral muscle in each plane of the intervertebral discs of the L 3-4、L 4-5 and L 5S 1. The CSA of multifidus in each plane of the intervertebral discs three months after operation were 6.56±1.26 cm 2, 6.87±1.31 cm 2, and 7.14±1.29 cm 2; the CSA of erector were 12.39±2.16 cm 2, 14.72±2.67 cm 2, and 16.45±3.09 cm 2; the CSA of psoas major were 7.05±1.52 cm 2, 8.12±1.75 cm 2, and 8.68±1.66 cm 2, which all were larger than those in conservative treatment group and showed significant difference between two groups ( P<0.05). However, the two groups had no significant difference in FI% of paravertebral muscle three months after operation. The CSA of multifidus in each plane of the intervertebral discs one year after operation were 6.43±1.23 cm 2, 6.62±1.42 cm 2, and 7.06±1.32 cm 2; the CSA of erector were 12.02±2.08 cm 2, 14.53±2.76 cm 2, and 16.39±2.84 cm 2; the CSA of psoas major were 6.98±1.47 cm 2, 8.01±1.59 cm 2, and 8.37±1.72 cm 2, which all were larger than those in conservative treatment group and showed significant difference between two groups ( P<0.05). The FI% of multifidus in each plane of the intervertebral discs one year after operation were 31.40%±5.84% , 32.54%±6.64% , and 33.26%±7.16% ; the FI% of erector were 22.64%±3.47% , 23.08%±3.72% , and 23.84%±3.99% ; the FI% of psoas major were 9.23%±2.20% , 9.72%±2.54% , and 10.98%±2.43% , which all were less than those in conservative treatment group and showed significant difference between two groups ( P<0.05). Two groups had significant difference in bed rest time as (9.21±2.52) d vs. (40.32±9.79) d ( t=37.79, P<0.001). The VAS, ODI score at the time of the first day after treatment and the last follow-up of the surgical treatment group were all significantly lower than those of conservative treatment group ( P<0.05). The operation could effectively improve the kyphosis deformity and reduce the loss the anterior column height of fractured vertebra compared with conservative treatment ( P<0.05). Conclusion:There exists paravertebral muscle degeneration of varying degrees during the course of the osteoporotic compression vertebral fractures. Compared to conservative treatment, percutaneous kyphoplasty treatment can not only significantly relieve pain in the short term, improve quality of patient's life, but also significantly delay the degeneration of paravertebral muscle.

Application of pathological indicators based on liver biopsy in the diagnosis of cirrhotic portal hypertension / 临床肝胆病杂志

Hepatic venous pressure gradient (HVPG) is the "gold standard" for diagnosing portal hypertension and determining its severity, but its wide clinical application is limited due to its invasiveness and difficulties in operation. The replacement of HVPG by noninvasive methods has become a research hotspot in recent years; however, the accuracy of the existing serological and imaging methods remains to be discussed, and such methods cannot completely replace HVPG in clinical practice. Liver biopsy has been widely used in clinical practice for many years and is still an indispensable method for the diagnosis of some liver diseases. Recent studies have found that several pathological indicators after liver biopsy, such as collagen area, fibrous septal thickness, nodule size, microvascular density, and density and area of bile ducts and lymphatic vessels, can not only judge the severity of liver fibrosis, but also have a good correlation with portal venous pressure, which provides new ideas for diagnosing cirrhotic portal hypertension and evaluating the severity of portal hypertension.

Construction of post competency-oriented training system for ultrasound residents / 中华医学教育探索杂志

The standardized training of resident doctors is the main form of medical education after graduation. The standardization training of ultrasound doctors was guided by post competence, and was explored from the aspects, such as training target, teaching management, teaching method, teaching mode, and examination means. In this study, we adhered to the tutor responsibility system, and horizontal multi-module and vertical step-by-step teaching modes, made study plans according to local conditions, and improved the assessment system, so as to build a standardized and practical training system for ultrasound residents.

Identification of four Armillaria strains and their effects on quality and yield of Gastrodia elata f. glauca / 中国中药杂志

In order to improve the quality and yield of Gastrodia elata f. glauca,determine the suitable Armillaria strains for the accompanying experiment in Xiaocaoba,Yiliang,four Armillaria strains were selected. They were used for G. elata cultivation,and the gene sequence,r DNA-ITS,β-tubulin and EF1-α of four Armillaria strains,were compared and analyzed. The yield was mesured in November which was based on previous laboratory research. The tubers were washed and steamed,then dried and powdered. The content of gastrodin and p-hydroxybenzyl alcohol was determined by UPLC,the polysaccharide was determined by phenol-concentrated sulfuric acid method. The results showed that the strains M1,M2,M3 and M4 were Armillaria gallica group but there were differences in the yield and active ingredient content when they were cultivated with the same G. elata. The yield of G. elata( Jian Ma) was the lowest when cultivated with Armillaria strain M3,but it was not the same when used M1,0. 981 kg·m-2,the highest yield in the four stains.The content of gastrodin was 0. 581%,the total content of gastrodin and p-hydroxybenzyl alcohol was 0. 595%,when accompanied with M1 strains. It was higher than other strains. The content of G. elata polysaccharide was 2. 132%,which was similar to the content of M3 strain,higher than that of M2 and M4 strain. Selecting phylogenesis of Armillaria strians,the content of active ingredient,and the yield as indicators,it was concluded concerned that the M1 strain was the best of four strains. The results will provide a theoretical basis and guidance for higher yield and quality in cultivation of G. elata in Yiliang.

The clinical comparison and status analysis of live donor renal transplantation between spouses / 实用医学杂志

Objective To investigate the status of living relative kidney transplantation, and the clinical effects and social significances of kidney transplantation between spouses. Methods We retrospectively collected the clinical data of the department of kidney transplant of the First Affiliated Hospital of Zhengzhou University, from January 2011 to December 2013. The spouse group as group 1, the age and sex of doners were taken into account,the siblings with the similar age of the same period were enrolled in group 2. Then the postoperative recoveries of the two groups were compared. Considering the current social status, particularly the shortage of donor kidneys, the clinical, social and family significances of kidney transplantation between spouses were analyzed. Results Twelve cases of spouses in group 1, 8 cases of siblings in group 2 , the differences of donor and recipient age of the two groups were 0.33 ± 0.98 years and 2.29 ± 7.23 years, respectively. The human major histocompatibility complex antigens (HLA) was less than three in group 1, and was greater than or equal to three in group 2. The changes of serum creatinine and urea nitrogen were analyzed. No significant differences of serum creatinine and downward trend of blood urea nitrogen were observed between two groups (P = 0.84, P = 0.79). Conclusion The kidney transplantation between spouses has good clinical efficacy and great social significance, improving the status of the shortage of donor kidney and contributing to family harmony. The renal transplantation between spouses has obvious advantages and need further promotion.

Applied anatomic study of narrow pedicle in thoracolumbar spine of adults / 中华骨科杂志

Objective To explore the demographic factors and the risk of the pedicle screw insertion of the narrow pedi?cles. Methods Thoracolumbar spine thin?section CT image data of 312 adults from September 2014 to September 2015 were ana?lyzed. The pedicle width,medial and lateral cortical thickness, spongy bone thickness, spongy bone thickness/cortical thickness, e angle and screw path length of each pedicle were measured. The incidence and the distribution characteristics of the narrow pedi?cle were analyzed. Anatomic parameters and age, gender and stature were compared between the narrow pedicle group and non?narrow pedicle. The risk of the pedicle screw insertion of the narrow pedicle was assessed. Results Among the 3 081 pedicles, 74 narrow pedicles were determined as their pedicles width were less than 5 mm, and the proportion of narrow pedicle was 2.40%. Among the 312 subjects, 26 subjects were found having narrow pedicles, and the proportion of individuals with narrow pedicles in the population was 8.33% (26/312). The incidences of narrow pedicle in thoracolumbar spine were T10 0.32%, T11 0.32%, T12 0.98%, L1 7.54%, L2 2.92%. The spongy bone thickness, spongy bone thickness/cortical thickness of narrow pedicle were lower than non?narrow pedicle. However, there were no significant differences of medial and lateral cortical thickness, e angle and screw path length between the narrow pedicle and non?narrow pedicle. Difference of the mean age between the two subjects groups had no statistical significance. The percentage of female in narrow pedicle subjects group was 84.6%(22/26), which was higher than that in non?narrow pedicle subjects group (49.7%, 142/286). The mean stature of the male and female of stenosis pedicle group subjects were 163.8±1.3 cm and 152.5±4.3 cm, which were shorter than those of non?narrow subjects pedicle group (169.5±5.6 cm, 160.1±6.6 cm). The percentage of the cortical bone breakthrough by the pedicle screws of narrow pedicle group was (84.6%, 27/32), which was higher than that of non?narrow pedicle group (14.7%, 33/224). Conclusion L1 is the most common segment of thoracolumbar spine that narrow pedicle exist, which is the result of reduction of the spongy bone thickness. Narrow pedicle mostly appears in short stature female. There is high risk of cortical bone breakthrough by insertion of the posterior pedicle screws in the narrow pedicle.

Research progress of Chinese medicine fumigation therapy in the treatment of joint pain disease / 国际中医中药杂志

This paper summarized the literature about traditional Chinese medicine fumigation treatment for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, lumbar disc herniation, cervical spondylosis, periarthritis of shoulder joint pain diseases. This paper aimed to provide reference for the study of Chinese medicine fumigation treatment of joint pain diseases.

Closed reduction and percutaneous locking compression titanium plate internal fixation in treatment of distal tibial fractures / 中国基层医药

Objective To evaluate operative methods and the clinical effect of closed reduction and percuta-neous locking compression titanium plate internal fixation in treatment of distal tibial fractures.Methods The clinical data of 21 patients with fracture who received closed reduction technology through the subcutaneous tunnel of fracture end,minimally invasive percutaneous treatment of tibial locking titanium plate fixation were retrospectively analyzed. Results All 21 patients were followed up from 6 to 18 months(11 months in average).All patients recovered with good healing of fracture.According to criteria of Johner -Wruhs score,the results were excellent in 12 cases,good in 6 cases,fair in 3 cases,and poor in 0 case.The excellent and good rate was 85.71%.Conclusion The method of closed reduction and percutaneous locking compression titanium plate internal fixation in treatment of distal tibial frac-tures can protect skin soft tissue,reduce the damage to the blood -supply of the fracture,promote the healing of the fracture and reduce complications.

Clinic opathologic analysis of granular cell tumor of esophagus / 局解手术学杂志

Objective To investigate the pathological feathers,diagnosis,differential diagnosis and prognosis of esophageal granular cell tumor. Methods The data of seven patients of esophageal granular cell tumor diagnosed from 2008 to 2014 in our hospital were analyzed. Seven cases of esophageal granular cell tumor were studied by hematoxylin-eosin and EliVision immunohistochemical staining,the clinical and pathological feathers were analyzed with review of the literatures. Results The pathological feathers of seven cases were very typical. The tumors located in the submucosa,and showed gray to grayish yellow,nodular,with no capsule. The size of these tumors ranged from 0. 4 ~1. 0 cm in diameter. Microscopically,the tumor cells were round,polygonal or spindle with small central nuclei and rich eosinophilic granules cytoplasm,the nucleolus could not be easily seen. Immunohistochemical stain showed that the tumor cells were positive for S-100,CD68 and NSE,but negative for SMA,Desmin,CK,CD34,CD117,DOG1,HMB45. The proportion of Ki-67 positive cells was very low. Histochemical stain showed that the tumor cells were positive for PAS. All 7 cases were benign,and the follow-up time was from 8 months to 6 years without recurrence in patients. Conclusion Granular cell tumor of esophagus is very rare in soft tissue tumors,most of which are benign and located in the middle and lower segment of esophagus. The tumor has a better prognosis. The definite diagnosis should depend on the pathological di-agnosis.

Transumbilical single site versus conventional three-port appendicectomy with a systematic review and Meta analysis / 国际外科学杂志

Objective This study aimed at evaluating the safety and feasibility of transumbilical single site laparoscopic appendectomy (SSLA) by systematic review and Meta analysis of literature comparing with conventional tree-port laparoscopic appendectomy (CLA).Methods The articles published from January 2000 to December 2012 were searched from electronic databases of PubMed,Embase,and the Cochrane Library.The literature with comparative studies of SSLA with CLA for adult patients was selected.And,the systematic review and Meta analysis carried out using Stata software.Results Eleven articles with 998 cases receiving operation during March 2008 to October 2011 were enrolled into study.There were 435 cases with SSLA and 563 cases with CLA.Compared the cases with SSLA and cases with CLA,there was no difference significantly in operative time (z =1.48,P =0.140),pain score in the 24 hours after surgery (z =0.83,P =0.409),diet start(z =0.38,P =0.707),postoperative complications (z =0.46,P =0.647),hospital stay (z =0.36,P =0.722).Conclusions SSLA are not different in operative time,postoperative pain,diet start,postoperative complications,hospital time comparing with that in CLA.

Impact of multidisciplinary team working on the management of colorectal cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The continual and rapid development of techniques which are used for diagnosis and treatment makes management of colorectal cancer more difficult depending on single discipline. Colorectal cancer multidisciplinary team (MDT) working model is recommended by UK and other countries, but there is little information on the impact of MDT working on management of colorectal cancer in China. The aim of this study was to assess the effect on management of colorectal cancer after the inception of an MDT.</p><p><b>METHODS</b>A total of 595 consecutive colorectal cancer patients were referred to the Department of Gastroenterological Surgery, the pre-MDT cohort include 297 patients, recruited from January 1999 to November 2002, and the MDT cohort had 298 patients enrolled from December 2002 to September 2006. Information recorded included: TNM stage from histological reports, degree of differentiation, the number of examined lymph nodes and CT TNM staging performed or not, and its accuracy, including local and distant recurrence.</p><p><b>RESULTS</b>The number of examined lymph nodes and the accuracy of TNM staging by CT in the MDT group were significantly more than those in pre-MDT group. CT TNM staging was more accurate in the MDT group compared to the pre-MDT group (P = 0.044). The rate of tumor recurrence in the MDT group was lower than pre-MDT group (log-rank test, P < 0.001). Multivariate analysis revealed that age (P = 0.001), management after inception of the MDT (P = 0.002), degree of differentiation (P = 0.003), number of examined lymph nodes (P = 0.002), and TNM stage (P = 0.000) were important factors that independently influence overall survival.</p><p><b>CONCLUSIONS</b>The inception of MDT working improved the diagnostic accuracy and overall survival of colorectal cancer patients. MDT working promoted communication and cooperation between disciplines and ensured high-quality diagnosis, evidence-based decision making, and optimal treatment planning.</p>

Effects of primary deep venous valvular incompetence of lower limb in deep vein thrombus after total knee replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of primary deep venous valvular incompetence of lower limb (PDVI) to the occurrence of deep vein thrombosis (DVT) after human total knee replacement (TKR).</p><p><b>METHODS</b>One hundred and twenty-six patients who planed to receive TKR were examined by color doppler flow imaging (CDFI). The patients were divided into 2 groups depending on whether they were found backstreaming in femoral vein or not. When the refluxing time > 1 s, the patients were included in PDVI group; When the refluxing time < or = 1 s, the patients were included in without PDVI group. In 7 d after operation all the patients were re-examined by CDFI to find if there was DVT. The results were tested by chi2 statistical analysis.</p><p><b>RESULTS</b>Among the 126 patients, 54 had PDVI, and 72 without PDVI. Fifty patients had DVT, total incidence rate 39.7% (50/126). In PDVI group 33 patients had DVT (61.1%, 33/54); In without PDVI group 17 patients had DVT (23.6%, 17/72), which was lower than PDVI group (chi2 = 21.227, P < 0.05).</p><p><b>CONCLUSIONS</b>PDVI may be a risk for occurrence of DVT after TKR.</p>

Ultrasonic study on the orthotopic prostate tumors of BALB/c nude mice / 中华超声影像学杂志

Objective To evaluate the value of high frequency color Doppler ultrasound in detecting the growth of orthotopic prostate tumor in nude mice. Methods Thirty-five orthotopic prostate tumor models of BALB/c nude mice were established. High frequency color Doppler ultrasound was used to monitor the growth of tumors in five randomly selected BALB/c nude mice after 2 - 8 weeks. After examination,the nude mice were immediately sacrificed under narcotism. The tumors were dissected, fixed and embedded. The sections were stained by HE and reviewed under microscope as the gold standard of detecting the growth of orthotopic prostate tumors. The growth curves were recorded and analyzed. Results High frequency color Doppler ultrasound can be used to observe the size, resonance, blood supply and necrosis of tumors. The tumors grew fastest in 4～6 weeks after injection. After seven weeks, necrosis can be found in the center of the tumors while the boundary of the tumor was not clear. Conclusions High frequency color Doppler ultrasound can be a reliable method to monitor the growth of orthotopic prostate tumor in BALB/c nude mice.

Effects of the Volatile Oil of Sandwort on Expression of CD54 in the Bronchial Epithelium Tissue of Acute Lung Injury Rat / 中华中医药杂志

Objective: To study the anti-inflamation effect of Volatile oil of Centipesa minima and the mechanism of action. Method: The “Two-hit” animal model of acute lung injury in rats was induced by oleic acid and lipopolysaccharide, to observe the protective effect of VOCM on acute lung injury in rats. Result: VOCM was able to suppress lung edema and high numbers of neutrophils, decrease the expression of CD54 in the bronchial epithelium tissue in the acute lung injury animal models. Conclusion: VOCM has a protective effect on acute lung injury in rats. Decreasing the expression of CD54 in the bronchial epithelium tissue may be one of its mechanisms of against respiratory tract inflammation.