According to clinical manifestations, 122 cases of subacute and chronic severe viral hepatitis confirmed by pathologic examination, were divided into two types. The severe jaundice-ascites(SJ-A) type accounted for 93 cases (76.2%) and the subfulminant hepatic failure (SFHF) type 29 cases (23.8%), with a ratio of 3.2 : 1. For SFHF type, hepatic encephalopathy was the first prominent feature and ascites might or might not appeared later. Therefore, this type was most easily misdiagnosed as fulminant hepatitis. In comparison with SJ-A type, the average elevation of serum bilirubin was lower and the average depression of prothrombin activivty more remarkable in SFHF type, suggesting that the degree of hepatic necrosis was more severer and the progress to hepatic failure more rapid. The mortality of SFHF type (93.1%) was markedly higher than that of SJ A type (62.4%) (x2 = 7.488, P

Objective To study the effects of IFN ?,TNF ?,IL 1 and dexamethasone on the expression of intercellular adhesion molecule 1(ICAM 1) of primary cultured human hepatocyte. Methods ICAM 1 expression of primary cultured human hepatocyte was induced in vitro by IFN ?,TNF ? and IL 1, measuring by cellular enzyme linked immunosorbent assay(ELISA). The effect of dexamethasone on human hepatocyte ICAM 1 expression was observed by adding dexamethasone into the cultured human hepatocytes prior to cytokine stimulation. Results The levels of ICAM 1 expression were significantly lower in unstimulated human hepatocytes than in human hepatocytes induced by IFN ?,TNF ? and IL 1. There were relations among the levels of ICAM 1 expression and cytokine concentration as well as induced period of time. Dexamethasone could partly inhibit the ICAM 1 expression on human hepatocytes induced by TNF ?,IL 1 and IFN ?.The inhibition rates were 40.3%?5.9%,38.1%?4.8%, and 37.6%?6.7%, respectively.Conclusions Enhanced ICAM 1 expression of primary cultured human hepatocyte may be induced in vitro by IFN ?,TNF ? and IL 1, which may be partly inhibited by dexamethasone.

Objective to summarize the clinical experience and results of 50 cases of mitral valve surgery via right anterolateral mini-thoracotomy technique. Methods Patients of mitral valve diseases who accepted such less invasive technique with cap lamp between October 2008 and February 2010 were reviewed.Out of a total 50 cases,38 rheumatic cases underwent mitral valve replacement,12 degenerative cases underwent mitral valvuloplasty,22 cases underwent associated tricuspid valvuloplasty.Preoperative transthoracic echocardiography(TTE) manifest mean left ventricular ejection fraction(LVEF) was 57.3±6.0%.According to NYHA classification,32 patients were in NYHA class II while the other 18 in class III. Diagnosis was identified according to history, physical examination, ECG as well as TTE. There was no statistical difference with regard to age, body weight, cradiothoracic ratio,size of left atrium,size of left ventricle and LVEF comparing with homochronous mitral valve surgeries via median sternotomy.All the patients adopted single lumen trachea cannula and were positioned on his/her back with a 20-30 elevation of the right side, the right arm was suspended over the head. Cardiopulmonary bypass was established between the femoral artery and bicaval venous cannulation. A 6-8cm incision was created in the right submammary fold and the right chest cavity was entered through the fourth intercostalspace.In addition,two other ports were necessary with one positioned at the cross-point of right medioclavicular line and second intercostalspace for placing long myocardial perfusion needles and superior vena cava blocking belt and the other positioned at the cross-point of right midaxillary line and fourth intercostalspace for placing special aortic clamp as well as inferior vena cava blocking belt. Surgeons should wearing headlamps to obtain a clear operation field. The procedures were then performed through an interatrial septum or interatrial groove incision.Result None of the 50 patients turned into median sternotomy during surgeries, there was no case of prolonged intubation, failure of important organs, hemoglobinuria or death,4 cases appeared hypoxemia during surgeries because of high-frequency ventilation with low tidal volume and all Improved after being treated. One case was complicated by active bleeding of intercostal arteries and recovered uneventfully after secondary hemostasis. Comparing with a group made up of 50 patients of the same period who underwent traditional mitral valve surgery through median sternotomy, there was no statistical difference regarding total operation time(130-206,152.0±42.6min:120-190,145.6±50.4min),the mean bypass time(58-147,75.1±20.3min:56-140,72.0±19.3min),the cross-clamp time (29-71,42.9±16.5min: 27-66,41.7±14.7min),mean parallel cycle time(18-60,28.5±12.8min:21-50,29.5±12.0min)(P>0.05). Tracheal intubation time was similar for both groups.(3.5-12,5.2±2.8h:4-14,5.5±2.6h)(P>0.05).The drainage volume of the mini-invasive group was significantly less when comparing with traditional group and all removed their chest tubes on 1st postoperative day.The mean volume were 40-600(105±40)ml and 150-1000 (300±80) ml, respectively(P<0.05). Volume of blood transfusion was also significantly less than traditional group(200±50ml:300±100ml)(P<0.05).TTE before discharged manifest all mitral valve prosthesis had good function, no paravalvular leak was detected, mitral regurgitation and tricuspid regurgitation following valvuloplasty was mild.Conclusion On-pump mini-invasive mitral valve surgery via right submammary thoracotomy which entered the right chest cavity through the fourth intercostalspace together with the using of headlamps can provide a clear operation field. The operating procedure is simple, more important, it is less invasive, less draining and has shorter mean hospital stay and hidden incision. The operation is safety and early postoperative result of this new procedure is satisfactory.

This study is based on the requirements of the construction of applied undergraduate colleges and development of excellent doctor education training pilot project of the ministry of education. The situation of higher medical education and the requirement of health career development are analyzed. The medical talents training mode of three oriented which is taking the post competency of medical students as the frame is constructed. This paper expounds the background proposed by training mode from the internal drive, external drive and project boosting. With the national education policy as the basis, the theoretical basis of the international advanced education teaching idea, theory and standard is explained. The connotation of the training mode is revealed by the humanistic quality education, professional quality training and physical and psychological quality cultivating. The evaluation strategy of clinical medical per-sonnel training standards, index system, the implementation approach and evaluation methods which have certain feasibility and timeliness is established.

BACKGROUND: Recombinant human erythropoietin (rhEPO) is a glycoprotein. Recent studies have demonstrated that rhEPO regulates many functional activities of neural cells. OBJECTIVE: To investigate the effects of different concentrations of rhEPO on proliferation of neural stem cells (NSCs) cultured in vitro. METHODS: Newborn Sprague-Dawley rat NSCs were harvested and cultured with serum-free culture medium containing different concentrations (5, 50, 500 U/mL) of rhEPO and 20 μg/L basic fibroblast growth factors (5, 50, and 500 U/mL rhEPO groups) and serum-free culture medium only containing 20 μg/L basic fibroblast growth factors (control group). After 7 days of culture, the cloning efficiency of NSCs was calculated. After 10 days of culture, neuron specific enolase (NSE)-and glial fibrillary acidic protein (GFAP)-immunoreactive cells were quantified. RESULTS AND CONCLUSION: In the rhEPO groups, cells proliferated rapidly, and the number of NSC microspheres was greater, in particular in the 50 U/mL rhEPO group, compared with the control group. NSCs grew faster in the 50 U/mL rhEPO group than in the control group. The number of NSE-and GFAP-immunoreactive cells was greater in the 50 U/mL rhEPO group than in the control group (P<0.01). These findings suggest that rhEPO promotes the in vitro culture and proliferation of NSCs, in particular 50 U/mL rhEPO.

Objective To evaluate the safety and efficacy of using blunt-tip needle to suture the dorsal venous complex (DVC) in laparoscopic radical prostatectomy. Methods The clinical data and the operation videos of patients, who received laparoscopic and robot-assisted radical prostatectomies by a single surgeon in our hospital from Jan. 2012 to Jul. 2014, were retrospectively reviewed. The needles used to suture DVC, exposure of suture points, bleeding of DVC, and cases of mistakenly sutured catheter and positive margins at the epic were analyzed. Continence of patients was followed and analyzed 3 months after surgery. Results A total of 104 cases were enrolled in this study. DVC was sutured with traditional needles in 56 cases, and in 52 of them the junction between prostate epic and membranous urethra (so called golden eye) could be exposed. DVC was sutured with blunt-tip needles in 48 cases, and the "golden eye" could be found in 44 of them. Suturing with blunt-tip needles, compared with traditional needles, resulted in significantly less bleeding and significantly better continence recovery (P<0.05). Conclusion Dorsal venous complex can be completely sutured by using blunt-tip needle once the "golden eye" is correctly indentified, which can decease the intraoperative bleeding and maintain a clear surgical field, improving the postoperative continence recovery.

One of the most challenging issues in the delivery of therapeutic proteins from PLGA-based microparticles is the stability and complete release of the protein in its native form. This review summarizes the methods to promote the stability and in vitro release of protein from PLGA-based microparticles. Protein stability is the precondition of complete release. One way to keep protein stability is to use stabilizer or modify protein to avoid denaturation and aggregation; another way is to avoid the pro-instability environment.

Objective To study the influence of different evaporation hardening methods, gelatin concentrations in inter aqueous phase and pH values of PBS on in vitro release modulus of alarelin-loaded microspheres (AR-MS). Methods The AR-MS was prepared by double emulsion solvent evaporation method (W/O/W); concentrations of internal aqueous phase with gelatin were 0%, 8% and 16% (W/V); and the volatilized hardening was done with room temperature magnetic stirring and low-temperature vacuum evaporation. Residual method assay was used to determine the accumulated release and burst release of AR-MS in PBS (pH = 4.5, pH = 7.0, pH = 10.0) on day 1, 7, 14, 21, 28, and 35. Scanning electron microscopy (SEM) was used to observe the degradation degrees of AR-MS at each time point. Results The method of volatized organic solvents could affect the release pattern of AR-MS, and the release pattern was also influenced by different concentrations of internal aqueous phase of gelatin. The fastest release rate of AR-MS was seen in medium with pH value being 10.0, complete release was not found in medium with pH being 4.5, and the most appropriate medium for AR-MS release was when pH value being 7.0. Conclusion Different evaporation hardening methods can influence the burst release of AR-MS, but has no influence on the overall in vitro release pattern. Different concentrations of internal aqueous gelatin phase can influence the in vitro release pattern, and the medium pH value can also influence the release of AR-MS.

This study was designed to evaluate the efficacy, tolerability, and sequential administration of abiraterone acetate (AA) and enzalutamide (Enz) for metastatic castration-resistant prostate cancer (mCRPC). A literature search was performed with PubMed, Embase, and Web of Science databases to identify relevant studies. Reviewed literature included published phase III trials of AA or Enz in mCRPC and studies regarding their sequential administration. Given the difference in control arms in AA (active comparator) and Enz (true placebo) randomized phase III studies, indirect comparisons between AA and Enz in mCRPC showed no statistically significant difference in overall survival in prechemotherapy and postchemotherapy settings (HR: 0.90, 95% CI, 0.73-1.11; HR: 0.85, 95% CI, 0.68-1.07). Compared with AA, Enz may better outperform control arms in treating mCRPC both before and after chemotherapy regarding secondary endpoints based on indirect comparisons: time to prostate-specific antigen (PSA) progression (HR: 0.34, 95% CI, 0.28-0.42; HR: 0.40, 95% CI, 0.30-0.53), radiographic progression-free survival (HR: 0.37, 95% CI, 0.28-0.48; HR: 0.61, 95% CI, 0.50-0.74), and PSA response rate (OR: 18.29, 95% CI, 11.20-29.88; OR: 10.69, 95% CI, 3.92-29.20). With regard to the effectiveness of Enz following AA or AA following Enz, recent retrospective case series reported overall survival and secondary endpoints for patients with mCRPC progression after chemotherapy. However, confirmatory head-to-head trials are necessary to determine the optimal sequencing of these agents.

Objective To investigate the effects of Tet-on gene regulated HIF-1?expression on cell apoptosis of hepatoma cells in vitro. Methods The apoptosis of hepatocellular carcinoma cell lines HePG2 was measured after HIF-1?expression was activated in HePG2 in vitro by Tet-on expression system. Results The amplified products were confirmed as the cDNA of HIF-1?by DNA sequencing, and obtained pTHE-HIF-1?was verified by endonuclease digestion. The HePG2Tet-on cells express HIF-1?constantly. After being incubated under different concentrations of doxycycline for 48 h, HIF-1?gene could inhibit HePG2 cell apoptosis. The apoptosis rates were 59. 6%、50. 9%、38. 1%、30. 5%、23. 9%、18. 3% respectively when the concentrations of doxycycline were 0?g/ml,0. 02?g/ml,0. 2?g/ml、1?g/ml、2?g/ml,5?g/ml (P