Aim To investigate the toxicity of isopsor-alen in HepG2 cells and its effects on bile acid, bile acid synthesis and transport. Methods Cell viability was evaluated by MTT assay and bile acid was deter-mined inside HepG2 cells, with exposure to various isopsoralen for 24h. The mRNA transcription of BSEP, MRP2, MRP3, NTCP, OATP2, OSTα, CYP7A1, CYP27 A1 , FXR and PXR were assessed by real-time PCR. Results The cell viability was decreased dose-dependently with isopsoralen in HepG2 cells, and IC50 was 118. 1μmol·L-1 exposure to isopsoralen for 24h. Bile acid inside cells significantly increased with 100 and 400 μmol · L-1 isopsoralen. Isopsoralen caused the down-regulation of MRP2 , MRP3 , CYP7 A1 mRNA at 25 μmol · L-1 . Beside these, the up-regulation of OATP2,OSTα,CYP27A1,FXR,PXR with 100 μmol· L-1 isopsoralen, but there was no significant change of BSEP and NTCP. Conclusion The results show that isopsoralen induces bile acid accumulation and cytotox-icity which may be associated with the down-regulation of MRP2, MRP3 in HepG2 cells.

Objective To investigate the comparative roles of the pathologic changes of gastrocnemius on the pathologic process of varicosis of the lower extremity(VLE). Methods By means of electron microscopy and light microscopy, image analysis and the capillary basement membrane and gastrocnemius muscle cell in 30 patients with VLE and 10 contrast subjects were studied. Results (1) Light microscopically, smearing of cross-striation, sarcolemmal proliferation, fibrinoid degeneration, fatty degeneration, and haemorrhage were seen in muscle of patients with VLE. (2) Electron microscopically, increase in thickness of the capillary basement membrane, increase in lipid droplets and glycogen, swelling of mitochondra, myelin figure, lipofusin, disruption of the myofibrils, and myopathic changes were seen in muscle cells of patients with VLE. The area and thickness of the capillary basement membrane in patients with varicosis were higher than those in the control subjects ( P 0.05). Conclusions (1) It is suggested that the ultrastructure changes of gastrocnemius muscles result from ischemia and hgpoxia. Among the changes, the capillary basement membrane plays an important role in the induce insuficiency of the calf muscle pump function which result in VLE extremities. (2) It is suggested that degeneration of gastrocnemius muscle cell may relate to the insufficiency of calf muscle pump function. (3) In early pathologic process, insufficiency of the calf muscle pump function can be compensate by muscle cells hypertrophy. The transverse areas of muscle cells in early period were bigger than that in later period, so that the compensation was limited, chronic ischemia and hypoxia can affecte the calf muscle pump function.

Objective To evaluate the effect of velocity of inspiratory flow on the severe asthma patients.Methods Twenty patients were ventilated thirty minutes respectively when the peak velocity of flow was 40L/min,60 L/min,80 L/min,100 L/min and 120 L/min,and then we measured their airway peak pressure(Ppeak),plateau pressure(Pplat)and intrinsic positive end expiratory pressure(PEEPi)and arterial blood gas analysis,accounting shunt fraction(QS/QT)and Dead space value(VD/VT).Results When velocity of flow enhanced from 40L/min to 60L/min,Ppeak increased while Pplat,PEEPi,VD/VT decreased obviously.When velocity of flow enhanced from 60L/min to 80L/min,Ppeak increased also but Pplat,PEEPi,QS/QT and VD/VT changed no significant.When velocity of flow enhanced from 60L/min to 100L/min,Pplat and PEEPi increased indistinctly while Ppeak,QS/QT and VD/VT increased distinctly.Conclusions The velocity of inspiratory flow,60~80L /min,can reduce PEEPi、QS/QT 及VD/VT and improve respiratory status.

Objective: To summarize the research progress of hydrogels for the regeneration and repair of degenerative intervertebral disc and to investigate the potential of hydrogels in clinical application. Methods: The related literature about the role of hydrogels in intervertebral disc degeneration especially for nucleus pulposus was reviewed and analyzed. Results: Hydrogels share similar properties with nucleus pulposus, and it plays an important role in the regeneration and repair of degenerative intervertebral disc, which can be mainly applied in nucleus pulposus prosthesis, hydrogel-based cell therapy, non-cellular therapy, and tissue engineering repair. Conclusion: Hydrogels are widely used in the regeneration and repair of intervertebral disc, which provides a potential treatment for intervertebral disc degeneration.

Objective To discuss the advance and experience of postoperative management in multivisceral transplantation(MVT).Methods Five patients with abdominal multiple organs malig- nances were subjected to multivisceral transplantation.The excised specimens included the liver,pan- creas,duodenum,stomach,spleen,mesentery and all of the involved lymph nodes.The transplanted organs were liver,pancreas,duodenum and parts of intestine.Patients were monitored and sustained stably in breath,hemodynamics and homoeostasis.The coagulation was also monitored and kept in balance.The intensive immunosuppressive protocol,including steroid,tacrolimus,mycophenolate mofetil and Zenapax,was used to prevent the acute rejection.The endocrine and exocrine of pancreas were tested,color Doppler examination was done every day,and Somatostatin was used to prevent pancreatitis.Drugs to bacteria,fungus and virus infection were prophylactically used.Results All patients waked up with 4-6 h after operation and began recovering with 3-7 days.Dynamic examina- tions revealed that the functions of grafted liver,pancreas and duodenum were satisfactory.No com- plications of acute rejection,pancreatitis,bleeding and thrombosis occurred.Conclusion Many ques- tions in postoperative management related to multivisceral transplantation are devoted to study.Nice experience of management to organ transplantation,detailed monitoring and prophylactically medica- tions are safeguards to steady recovering and further prognosis.

Objective To compare the efficacy of internal fixation with non-operative treatment of traumatic flail chest combined with sternal fracture.Methods A retrospective review was made on 102 patients with traumatic flail chest combined with sternal fracture treated from January 2007 to January 2014.There were 71 patients in operation group and 31 patients in non-operation group.Operation group was allocated to pure titanium rib plating (Group Ⅰ,22 cases),porous titanium screw fixation (Group Ⅱ,20 cases),and nickel-titanium memory alloy sternal rib plating (Group Ⅲ,29 cases).Rib traction was performed in non-operation group.Clinical results and incidence of complications were compared between the two groups.Results At 24 and 72 hours,operation group was superior over non-operation group with regard to HR [(100.4 ± 9.5) times/min vs (105.2 ± 10.1) times/min,(92.1 ± 9.9) times/min vs (102.1 ± 9.2) times/min],MAP [(97.7 ± 14.5) mmHg vs (91.0 ± 13.3) mmHg,(112.5 ± 15.2) mmHg vs (93.1 ± 13.8)mmHg] and CVP [(7.8 ±3.7)cmH2O vs (9.4 ±3.8)cmH2O,(6.2 ±2.9)cmH2O vs (9.1 ±3.2) cmH2 O] (P ＜ 0.05).Duration in ICU [(5.1 ± 0.8) days vs (9.3 ± 1.1) days],ventilation time [(4.5 ±1.0)days vs (8.2 ± 1.4)days],hospitalization time [(14.6 ±3.5)days vs (23.3 ±4.4)days] and incidence of complications were significantly lower in operation group than in non-operation group (P ＜ 0.05).Two months after discharge,tidal volume (VT) [(0.52 ±0.04)L vs (0.40 ±0.03)L],inspiratory capacity (IC)[(1.99 ±0.45)L vs (1.22 ±±0.33)L],forced vital capacity (FVC) [(3.52 ±0.51)L vs (2.44 ±0.42)L],total lung capacity (TLC) [(5.41 ±0.82)L vs (3.72 ±0.56)L] and forced expiratory volume in one second (FEV1) [(2.80 ± 0.43) L vs (1.95 ± 0.50) L] showed significantly better results in operation group than in non-operation group (P ＜ 0.05).Operation time,intraoperative bleeding and daily drainage volume were (38.8 ±9.2)min,(43.5 ±7.6)ml and (10.9 ± 1.1)ml in Group Ⅱ versus (62.5 ± 10.1)min,(100.0 ± 10.5) ml and (26.8 ±3.1)ml in Group Ⅰ and (49.3 ±9.6)min,(61.4 ±8.3)min and (19.8 ±1.6)ml in Group Ⅲ (P ＜ 0.01).Conclusion For traumatic flail chest combined with sternal fracture,the internal fixation should be done as early as possible so as to reduce incidence of complications.Relatively,porous titanium screw fixation has better clinical outcome.

Objective To survey and compare the awareness and attitude of hospice care among medical staff from hospitals ranked 1, 2, and 3. And to examine the association of hospital grading with awareness and attitude of hospice care. So that this study would promote orientation for hospice care theoretically. Methods A cross-sectional questionnaire survey was performed among medical staff in Suzhou to investigate the awareness and attitude of hospice care from hospitals ranked 1, 2, and 3. Generalized linear regression model was applied to examine the association of hospital levels with awareness and attitude of hospice care. Results A total of 990 individuals were surveyed. Among them, 580 were from hospitals ranked 3, 252 were from hospitals ranked 2, and 158 were from hospitals ranked 1. The attitude to someone self′s death scored 7.2 ±2.1, 7.6 ±2.4, 7.2 ±2.1, the attitude to patients′death scored 11.0 ±2.6, 11.6 ±2.3, 11.5±2.3, there was a significant difference among the 3 levels (F=3.34, 3.69, all P<0.05). After controlling for age, education level, years of work, religion status, family type, and disease condition in family, as compared with hospitals ranked 3, the average score of the awareness of hospice care decreased 0.431 (P=0.049) and the average score of attitude to hospice care decreased 2.944 (P=0.022) in medical staff from hospitals ranked 1. As for the 7 aspects of hospice care attitude, the average score of attitude to patients′death decreased 0.634 (P=0.003), the average score of attitude to implementation of hospice care for patients and their families decreased 0.926 (P=0.046), and the average score of supporting hospice care decreased 0.664 (P=0.011) in medical staff form hospitals ranked 1 as compared with hospitals ranked 3. We failed to find a significant difference in awareness and attitude of hospice care between hospitals ranked 2 and 3 (all P>0.05). Conclusions The awareness and attitude of hospice care is poorer in medical staff from hospitals ranked 1 as compared with those from hospitals ranked 2 or 3. Our finding suggests that medical staff from hospitals ranked 1 is a target population on whom hospice care training would be performed.

Authors described the patterns,core measures and mechanisms of coordinated care delivery in the localities and analyzed initial outcomes of this practice.It is found that such practice has optimized distribution of regional healthcare resources,implemented first visit to primary institutions, and the care delivery to separate emergency from outpatient service.In addition,the paper analyzed problems found in localities in terms of policy,public hospitals and primary institutions,and proposed elements required for coordinated care delivery system to succeed,such as enhanced policy support, enhanced multi-departmental coordination,and public hospital reform to explore feasible approaches.

This paper summarized practices and experiences of other countries in coordinated care delivery system building,and described the care delivery systems used in various healthcare fundraising patterns.It is found that most countries have defined duties and service coverage of healthcare institutions at all the levels and measures to ensure rational patient flow.In the end,the paper concluded found experiences of these countries and inspirations for China.

Abnormalities, Multiple ; blood ; diagnosis ; metabolism ; physiopathology ; Child ; Diagnosis, Differential ; Dwarfism ; blood ; diagnosis ; metabolism ; physiopathology ; Estradiol ; blood ; Female ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Silver-Russell Syndrome ; blood ; diagnosis ; metabolism ; physiopathology