Gynecology of traditional Chinese medicine (TCM) is a clinical subject concentrating on women's specific diseases. With the advance of the time, clinical gynecology of TCM has to be developed from clinical practice and establish an open mode of multivariate diagnosis and treatment. The author of this article expatiates on the relationships between syndrome differentiation and disease identification, constitution differentiation and syndrome differentiation, stage differentiation and syndrome differentiation, time differentiation and syndrome differentiation, macroscopic differentiation of syndrome and microcosmic differentiation of syndrome, and integral syndrome differentiation and local syndrome differentiation, and then states that it is necessary for us to establish a multivariate diagnosis system to adapt to the complex clinical practice.

OBJECTIVE:To explore the effects of sufentanil combined with remifentanil on the hemodynamics,stress re-sponse and analgesic effect of elderly patients with abdominal surgery by general anesthesia. METHODS:170 elderly patients with abdominal surgery by general anesthesia were randomly divided into control group and observation group,85 cases in each group. All patients received general anesthesia. Control group induced anesthesia by 4 ng/kg remifentanil and maintained by 5 ng/kg;obser-vation group induced anesthesia by 3 ng/kg sufentanil and 2 ng/kg remifentanil,maintained by 0.15 mg/(kg·h)remifentanil and 3 ng/kg remifentanil. Heart rate(HR)and mean arterial pressure(MAP)before anesthesia induction,immediately intubation,1 min after intubation,abdominal entry and 1 min after extubation,norepinephrine and epinephrine levels before anesthesia induction,1 min after intubation,1 min after extubation,6 and 12 h after surgery in 2 groups were observed,restlessness and alertness/seda-tion scores after extubation,6,12,24 h postoperative visual analogue scede (VAS) score and the incidence of adverse reactions were compared. RESULTS:HR and MAP levels in 2 groups immediately intubation,1 min after intubation,abdominal entry and 1 min after extubation significantly changed,HR and MAP levels in observation group 1 min after intubation,abdominal entry and 1 min after extubation were significantly lower than control group,the differences were statistically significant(P<0.05);nor-epinephrine and epinephrine levels in 2 groups 1 min after intubation,1 min after extubation,6 and 12 h after surgery significant-ly changed,and observation group was lower than control group,the differences were statistically significant(P<0.05);restless-ness and alertness/sedation scores after extubation,6,12,24 h VAS score in observation group were significantly lower than con-trol group,the differences were statistically significant(P<0.05). There was no significant difference in the incidence of adverse reactions between 2 groups (P>0.05). CONCLUSIONS:Sufentanil combined with remifentanil can effectively stabilize hemody-namics of elderly patients with abdominal surgery,reduce the stress response levels and improve the postoperative analgesic ef-fect,with good safety.

Objective To explore the effects of Interleukin 10 (IL 10) on the endothelial damage mediated by inflammatory cytokines in Kawasaki disease (KD).Methods Human umbilical vein endothelial cells were cultured in vitro and the production of tumor necrosis factor alpha (TNF ?),interleukin 1 beta (IL 1?),interleukin 6 (Il 6) and IL 10 were measured by enzyme linked immunosorbent assay (ELISA).The proportion of apoptotic cells in endothelial cells induced by the supernatants of peripheral blood mononuclear cells (PBMCs) was detected by Annexin V/PI double staining though flow cytometry.Electrophoretic mobility shift assay (EMSA) was used to detect the activity of nuclear factor ?B (NF ?B).Results The level of TNF ?,IL 1?,IL 6 and IL 10 were markedly increased in KD patients and the proportion of apoptotic cells in endothelial cells induced by the cultured supernatants of PBMCs was markedly elevated (38 4?7 8)% compared to (2 8?0 8)% in the control subjects.The apoptosis of endothelial cells induced by the cultured supernatants of PBMCs could be reversed to some degree by anti TNF ?,IL 1? and IL 6 monoclonal antibody (McAb),otherwise could be enhanced (58 6?14 6)% by anti IL 10 McAb.The activity of NF ?B in the activated PBMCs in KD patients was distinctly increased and IL 10 could significantly inhibit the activity of NF ?B,reduce the production of TNF ?,IL 1? and IL 6 and the apoptosis of endothelial cells induced by the cultured supenatants of PBMCs in KD patients.Conclusion IL 10,which can inhibit the activity of NF ?B and the transcription of inflammatory cytokines such as TNF ?,IL 1? and IL 6,acts as an important protective factor in endothelial damage of KD.

Objective To observation the changes of left atrium and pulmonary veins(PV)in patients with atrial fibrillation(AF) by transthoracic two-and three-dimensional echocardiography. Methods Transthoracic echocardiography were applied in 126 patients,which were divided into sinus rhythm(SR) group(64 cases)and AF group(62 cases),AF group were further divided into two subgroups:the paroxysmal AF and non-paroxysmal AF group.Left atrial area(LAA),left atrial volume(LAV),left atrial diameter(LAD)were measured by 2-dimensional echocardiography imaging.PV diameters were measured by three-dimensional echocardiography. Results Compared with SR group,PV diameters were significantly increased in AF group(P＜0.05).In patients with AF,PV diameters in non-paroxysmal AF group were larger than paroxysmal AF group.The four PV diameters in SR,paroxysmal AF and non-paroxysmal AF group did not show statisticant difference(P＞0.05).Compared with SR group,LAD,LAA,LAV were increased in AF group.LAD,LAA,LAV were larger in non-paroxysmal AF group than SR group and paroxysmal AF group(P＜0.05).Conclusions Left atrium and PV dilate significantly in patients with AF,transthoracic echocardiography could be a non-invasive method to observe left atrium and PV.

AIM: To investigate whether efficient production of neuron-like cells from embryonic stem cells(ESCs) can be indued by astrocyte-conditioned medium(ACM) in vitro.METHODS: Based on the 4-/4+ protocol established by Bain,two groups were studied: ATRA group,ATRA with ACM group.ESCs were induced into neuron-like cells by means of three-step differentiation in vitro.The totipotency of ESCs was identified by the observation of cells' morphology and the formations of teratoma in immunocomprised mice.The cell differentiation was evaluated continuously by detection of the cellular specific markers of neural stem cell, neurons and astrocytes such as nestin,NF-200,NSE and GFAP using immuno-histochemistry assay.RESULTS:(1) The ESC-D3 cells kept the ability of differentiation into cellular derivations of all three primary germ layers after continuous passage culture.(2) The ratio of NF-200 and NSE positive cells in the cells induced by ATRA with ACM was higher than that in the cells induced by ATRA only.(3) Finally,the positive rate of the neuron-like cells was up to 73.5% in the group induced by ATRA with ACM.CONCLUSION: The ESCs are induced into neuron-like cells with high purity and efficiency by ATRA with ACM.

Objective:To investigate the levels of periphreal blood free carnitine and amino acids in healthy pregnant women in the third trimester and their association with maternal, fetal, and neonatal cardiac function and structure.Methods:This prospective descriptive study included healthy singleton pregnancies who underwent routine obstetric examination and delivered in two district maternal and child health hospitals (one in the urban and one in the suburb an area) in Beijing from June 2017 to February 2018. All recruiters had serology Down's syndrome screening test at (18±1) gestational weeks. Besides measurement of amino acids and free carnitine levels in whole blood and urine samples by liquid chromatography-tandem mass spectrometry, all cases underwent maternal and fetal echocardiography at (35±1) weeks of gestation. And neonatal echocardiography was performed after delivery to assess the heart function and structure. Antenatal factors were also collected, including maternal education background, age at first marriage and conception, gravidity, and folic acid supplement in early pregnancy. Statistical analysis was performed using t-test, ANOVA, Chi-square test, Pearson correlation coefficient, and Kappa test. Results:A total of 493 mother-neonate dyads were enrolled in this study. Blood free carnitine levels in the healthy pregnant women in the third trimester ranged from 5.09 to 59.17 μmol/L (reference value: 10.00-50.00 μmol/L) with an average value of (13.03±3.87) μmol/L. None was found with structural abnormalities by cardiac ultrasound, showing an average left ventricular end diastolic diameter (LVEDD) and end systolic diameter (LVESD) of (45.70±3.08) mm and (29.17±3.12) mm, respectively, and left ventricular ejection fraction (LVEF) of all cases were over 55%. No cardiac malformation was detected by the third-trimester fetal echocardiography. The average birth weight of the 493 newborns was (3 340±313) g. Those whose birth weight <2 500 g and >4 000 g were accounted for 1.0% (5 cases) and 3.0% (15 cases) with the average maternal blood free carnitine level of (13.25±2.17) μmol/L (10.46-19.21 μmol/L) and (12.64±2.50) μmol/L (8.78-17.73 μmol/L) ( t=0.42, P>0.05). The average LVEDD and LVESD of the 493 newborns were (17.21±1.27) mm and (11.03±1.30) mm, respectively. For the 64 newborns (13.0%) whose LVEF<60%, the maternal blood free carnitine level was (12.93±2.78) μmol/L (7.34-22.13 μmol/L), showing no statistical difference ( t=-0.29, P>0.05) with those 59 neonates (12.0%) whose LVEF over 75% and maternal carnitine level of (13.09±3.24) μmol/L (8.66-27.49 μmol/L). All cases were divided into four groups based on the quartiles of maternal blood free carnitine level and no significant difference in maternal or neonatal LVEDD or LVEF was observed among these groups (all P>0.05). Conclusions:Blood free carnitine concentration in healthy pregnant women in the third trimester is at the lower limit of normal range, and no significant effect on maternal cardiac function and fetal cardiac structure is seen. However, the effect of low maternal carnitine level in the third trimester on children's myocardial function and whether carnitine should be supplemented in the third trimester are worthy of further investigation with larger sample size.

Objective To observe tigecycline (TGC),minocycline (MH)and polymyxin B (PB)in vitro antibacterial activity of pan-resistant Acinetobacter baumannii (PDR-Ab)for clinical treatment,provide the basis for infection control.Methods Collected 76 patients’clinical specimens used for no repeat count of isolation and identification with pan-resistant Acineto-bacter baumannii in Shaanxi Provincial People’s Hospital from October 2013 to March 2013.Used tigecycline,minocycline and polymyxin B to do susceptibility testing with disk diffusion method (KB).Results 76 pan-resistant Acinetobacter bau-mannii ,sensitive to the rate for tigecycline and polymyxin B were 100% sensitivity rate of minocycline and intermediary rates were 67.11%,27.63%.Conclusion Tigecycline,minocycline and polymyxin B for the Pan-resistant Acinetobacter bau-mannii had good in vitro antibacterial activity.It provide a reference for clinical pan-resistant Acinetobacter baumannii infec-tions caused by diseases treatment.

AIM:To explore the supportive and expansive effects of aorta-gonad-mesonephros(AGM) region derived stromal cells on hematopoietic stem cells(HSC) in vitro.METHODS:The murine stromal cells were separated and cultured from AGM region of a 11 day postcoitum(dpc) mouse embryo and 6 week mouse.After identification by Wright's staining and flow cytometry,the stromal cells were co-cultured with the embryonic stem cell(ESC)-derived,cytokine-induced HSCs,and the maintenance and expansion of HSCs were evaluated by detecting CD34+,CD34+Sca-1+cells with flow cytometry.Blast colony-forming cell(BL-CFC) and high proliferative potential colony-forming cells(HPP-CFC) were determined by semi-solid medium clonal culture.RESULTS:AGM-derived and bone marrow(BM)-derived stromal cells were similar in morphology and phenotype,and had common character of stromal cells.Supported by AGM stromal cells or by BM stromal cells,more primitive progenitor cells HPP-CFC were expanded,but BL-CFC expansion was only detected in AGM-derived stromal cells.In the supporting of BM stromal cells CD34+ hematopoietic stem/progenitor cells were expanded 3-4 times,but no significant expansion in CD34+Sca-1+ cells was observed.While in the supporting of AGM stromal cells,both CD34+ hematopoietic stem/progenitor cells and CD34+Sca-1+ cells were expanded significantly from 4 to 5 times,respectively(P