“Three Yin and Three Yang” syndrome differentiation is a method and system generated from “Treatise on Febrile Diseases”. And it is a principle of syndrome differentiation and a criterion of treatment. Modern physicians give many descriptions on levels of “Three Yin and Three Yang” syndrome differentiation. There are a lot of different opinions on it, including “Yin and Yang”, ”three steps of Cluster analysis”, “one divided into two” combining with “one divided into three”, and “three steps of recognizing symptom, understanding disease and differentiating syndrome” theories. The author believes “Three Yin and Three Yang”syndrome differentiation consists of three levels:differentiating syndrome principle, differentiating syndrome category and differentiating syndrome type. Strengthening research on levels of syndrome differentiation helps to improve accuracy of syndrome differentiation, guide drug description and enhance clinical efficacy.

Precision medicine is currently being paid much attention and greatly promotes the diagnosis and treatment of various diseases,especially cancer.Surgery plays a pivotal role in the treatment of hepatocellular carcinoma (HCC) and precision hepatectomy stands as the most updated surgical idea.Application of the concept and techniques of precision medicine to further improve HCC surgery,consummate the skills and modalities of HCC surgical treatment,enrich the nature of precision hepatectomy,so as to make precise evaluation,early prediction,reduce postoperative recurrence and metastasis,find biomarkers of molecular targeted therapy and improve the prognosis is the prime task of HCC surgery.

Objective:To detect the pain status and the pain management of home-based advanced cancer patients, and to investigate the key factors impacting the satisfaction on pain management.Methods:Totally the data of 138 cases from the hospice department in the duration from Jan. 2019 to Jun. 2019 were collected and analyzed by χ2 test with SPSS 23.0. Results:109 cases in 138 cases received analgesics treatment before, 54.13% of these participants expressed satisfaction with the effect of their pain management, and 45.87% showed unsatisfied on their pain management. Cancer clinical stage and PMI (pain management index) were both detected to be the significant factors for satisfaction of pain management ( P<0.05, P=0.029; P<0.01, P=0.001) . Conclusions:Cancer clinical stage and PMI are found to be related to the satisfaction for pain management. The percentage of patients who use opioids increased. while there was still a part of patients suffering from inadequacy of pain management. The pain management for home-based advanced patients needs to be paid more attention by medical staff.

Objective To clarify the effective location of propofol in central nervous system (CNS). Methods Forty-two Wistar rats were ramdomized into control group,50 mg/kg propofol,100 mg/kg propofol,150 mg/kg propofol,tail shearing,propofol followed by tail shearing (n=7 in each group). The NOS expressions in the CNS were recorded by NADPH-d histochemistry after anesthesia by intraperitoneal injection of propofol. Results Rather widely stained NOS positive neurons were observed in the control group. In propofol groups,the NOS expressions were decreased significantly as compared with the control group,mainly located in ACB,LS,Pe,VLG,Den,SO,SCh,AVPO,Sol,SuM,BL,PV,LHb and Icj,showing a negative dose-effect relation with propofol. Conclusion Propofol has the determined sites of action in CNS and the decrease of NO synthesis by the inhibition of NOS may play a role in propofol-induced general anesthesia.

Nrf2,a key transcriptional factor in regulating endog-enous antioxidant signaling pathway,maintains the redox bal-ance by controlling the expression of a battery of antioxidant en-zymes,phase-Ⅱ detoxification enzymes and phase-Ⅲ transport-ers.Furthermore,Nrf2 regulates inflammation.Recent resear-ches have confirmed that Nrf2 provides a vital physiological role in kidney diseases,activation of Nrf2 enhances the antioxidant and anti-inflammatory ability in cellular and tissue levels,thusalleviates renal injury.Here,this article aims to summarize the protective effect of Nrf2 on various models of kidney impairment and explore the potential of Nrf2 as a therapeutic target to pre-vent kidney diseases.

Objective To clarify the effective location of propofol in central nervous system (CNS) by detection of the c-jun expression after propofol-induced anesthesia in rats. Methods Wistar rats were randomly divided into 6 groups: normal control (C), low-dose propofol group (50 mg/kg, P 1), middle-dose propofol group (100 mg/kg, P 2), high-dose propofol group (150 mg/kg, P 3), stimulation with tail broken group (S 1), and propofol + stimulation with tail broken group (S 2). The expressions of nucleoprotein JUN in the CNS were detected by immunohistochemisty. Results Rather weakly stained nucleoprotein JUN positive neurons were observed in the supraoptic nucleus, lateral septal nucleus, and lateral habenular nucleus in the control group. In groups P 1, P 2, and P 3, the expressions of nucleoprotein JUN were increased significantly as compared with those in the control group. The expressions were mainly located in the accumbent nucleus, lateral septal nucleus, periventricular hypothalamic nucleus, ventral lateral geniculalaten nucleus, dorsal lateral geniculate nucleus, supraoptic nucleus, suprachiasmatic nucleus, anteroventral preoptic nucleus, nucleus of the solitary tract, supramammillary nucleus, basolateral amygdaloid nucleus, paraventricular thalamic nucleus, lateral habenula nucleus, and islands of Calleja. The expressed positive neuron number was positively correlated with the doses of propofol. Conclusion Propofol anesthesia has the determined sites of action in rat CNS.

Objective To explore the clinicopathologic features,diagnosis,treatment and prognosis of ACTH-independent subclinical Cushing syndrome caused by cortisol-secreting and hypo-androgen black adrenal cortical adenomas with lipomatous metaplasis.Methods The clinical and pathologic features of 1 patient presented with hypo-androgen and atypical signs and symptoms of Cushing syndrome were reported.The patient's 24 h UFC (235.62 μg) was higher than normal range,his plasma ACTH concentrations (＜1.1 pmol/L,was lower than normal range and his serum cortisol concentrations lacked diurnal rhythm.There was absence of serum cortisol suppression in overnight dexamethasone suppression tests.Serum levels of androgens (1.2 nmol/L) were lower than normal range.24 h urine catecholamine was normal,NE was 160.5 nmol/24 h (5-591 nmol/24 h),E was 23.1 nmol/24 h (0-82 nmol/24 h),DA was 1496nmol/24 h (424-2612 nmol/24 h).Aldosterone lying and standing test:ALD1 138-415 pmol/L,AT-Ⅱ1 64.54 ng/L,PRA1 0.80 μg · L-1 · h-1 Abdomen CT showed right adrenal mass (3.1 cm).131Ⅰ-MIBG scanning was normal.Adrenocortical carcinoma was considered as a possible diagnosis based on cortisol hypersecretion,hypo-androgen and the imaging characteristics.This patient accepted laparoscopic adrenal adenoma resection.Results The adrenal tumor size was 3.5 cm.Immunohistochemical (IHC) staining showed Melan-A,CgA,α-inhibin and Syn positive and Ki-67 ＜ 1％.Histopathologic results showed black adrenal cortical adenomas with myelolipomatous change.After surgery,patient's serum androgen was normal,and the signs and symptoms of Cushing syndrome and oligo-androgen disappeared.There was recurrence after 1.5 years follow-up.Conclusions Although most patients with corticotropin-independent Cushing syndrome associated with abnormal androgen proved to have adrenocortical carcinoma,the clinician should be aware of the possibility of benign,black adrenal adenoma.

Aim To study the apoptotic inducing effects of deguelin on SH-SY5Y cells.Methods SH-SY5Y cells were treated with 0,0.625,1.25,2.5,5,10 and 20 μmol·L-1 deguelin for different time(24,48,72 h);cell viability was detected by CCK-8 assay.SH-SY5Y cells were treated with 0,8,20,50 μmol·L-1 deguelin for 24 h;light microscope and AO/EB double stained method were employed for observing the morphology and apoptotic morphology of treated cells.Apoptotic rate of treated cells was determined by flow cytometry.Cells were stained by DCFH-DA,and the whole reactive oxygen species(ROS)was determined by flow cytometry.Spectrophotometry was employed to determine the activation degree of caspase-3.Results Deguelin inhibited cell growth in a time-and dose-dependent manner,and the IC50 value of deguelin was(26.07±2.18),(18.33±0.94),(12.5±1.49)μmol·L-1 when treated with 24,48,72 h respectively.After treated with 8,20,50 μmol·L-1 deguelin for 24 h,cell apoptotic rate,ROS and activation rate of caspase-3 increased markedly(P<0.05),all of which performed a dose related effect.Conclusion Deguelin can inhibit SH-SY5Y cell proliferation and induce cell apoptosis,and the mechanism may be concerned with the elevated ROS and activated caspase-3.

Objective To investigate the effects of Urotensin Ⅱ(UⅡ)on proliferation of rat pheochromocytoma cell line(PC12) and primary cultured human pheochromocytoma cells.Methods We observed the effects of UⅡ on the proliferation of rat PC12 cells and human pheochromocytoma cells in vitro by MTT method.Results 1.UⅡ had no obvious effect on the proliferation of rat PC12 cells.2.UⅡ(at 10-7 and 10-6mol/L) promoted the proliferation of primary cultured human pheochromocytoma cells. Conclusion UⅡ stimulates the proliferation of human pheochromocytoma cells and probably plays a role in the pathogenesis of pheochromocytoma.

Objective To develop a new method to expose the stellate ganglion to increase the success rate of establishing a dog model of atrial fibrillation indinced by sympathetic stimulation .Methods A total of 28 adult dogs were randomly divided into traditional group and improvement group , 14 dogs in each group .The stellate ganglions were separated by the two different methods , respectively , to establish a sympathetic stimulation induced atrial fibrillation model in all the dogs .Changes of vital signs , survival rate of the dogs and the voltage required to stimulate the stellate ganglion were recorded intraoperatively .Changes of cardiac electrophysiology were recorded before and after electric stimulation . The levels of released neurotransmitters were detected by immunohistochemistry . Results The survival rate of the improvement group was 100%(14/14), significantly higher than the 64.3%(9/14) of the traditional group (P<0.05). The operation time of the improvement group was 122.71 ±3.62 min, significantly shorter than the 269.44 ±8.79 min of the traditional group (P<0.05).The threshold voltage of the improvement group was significantly lower than that of the traditional group ( P<0.05) .Conclusions Our modified surgical procedure can effectively reduce the mortality of dogs , significantly shorten the operation time , and reduce the intraoperative blood loss , keeping a more intact stellate ganglion , and maintains a more stable voltage of electric stimulation , Therefore, it is a new method more suitable for establishment of a sympathetic stimulation induced atrial fibrillation model in dogs .