OBJECTIVE:To investigate the effect of flurbiprofen on morphine doses and intestinal function recovery after radi-cal gastrectomy for gastric cancer. METHODS:102 patients underwent radical gastrectomy of gastric cancer were randomly divided into control group and observation group,with 51 cases in each group. Control group was treated with routine morphine analgesia pump,and observation group was additionally given intravenous injection of flurbiprofen 50 mg before operation and 24 h after op-eration on the basis of control group. VAS,comfort score(BCS),the amount of morphine and intestinal function recovery were ob-served and recorded in 2 groups. RESULTS:48 h after operation,there was no statistical significance in VAS and BCS scores be-tween both groups(P>0.05),but the dose of morphine in observation group was significantly less than in control group,with sta-tistical significance (P<0.05);the postoperative recovery time of bowel sounds and the first anal exhaust time in observation group were significantly shorter than control group,and the incidence of nausea and vomiting in observation group was significant-ly lower than control group,with statistical significance (P<0.05). CONCLUSIONS:The application of flurbiprofen combined with morphine in gastrectomy can reduce the dose and ADR of morphine based on the same analgesic effect,and it is good for the recovery of intestinal function.

Objective To investigate clinical effects of neoadjuvant chemotherapy(NAC)for phase II B breast cancer.Methods From Jan.2002 to Nov.2004,330 female patients with phase II B unilateral breast cancer were enrolled in the study and they were randomly divided into 2 groups.Group A was NAC group and 152 cased were enrolled in this group,among whom 78 cases had left-side cancer and 74 cases had right-side cancer.The mean age of group A was 42.6 years(ranging from 32 to 73 years).Group A were given beth taxane-and anthracycline- based chemotherapy,according to the protocol of group A.After 4 cycles of chemotherapy,patients in group A underwent conservative breast surgery or radical mastectomy according to the result of chemotherapy.Group B,the non-NAC group,had 178 cases in it,among whom 98 had left-side cancer and 80 had rightside cancer.The mean age of group B was 41.4 years(ranging from 31 to 72 years).Group B also underwent conservative breast surgery or radical mastectomy according to tumor size and axillary node status.According to standards of International Union against Cancer(UICC),the primary focus and axillary node status in NAC group were analyzed before and after chemotherapy.Results Group A had a total effective rate of 91.45%.Breast conservation rate in group A and group B was 44.70%and 21.90%respectively.The overall 3 and 5 year survival rate in group A was 96.05%and 75.00%respectively.which was significantly higher than that in group B.Conclusion NAC is effective in reducing clinical stage of phase II B breast cancer,which increases breast conservation rate and postoperative survival rate.

From the development of national clinical research base of traditional Chinese medicine ( TCM ) in Longhua Hospital, Shanghai University of Traditional Chinese Medicine, we made a success of construction, such as planning and foundation , curative effect , study protocol , standards , platform establishment . From the thinking to results , we made knowledge of the situation in order to provide references for the further building of clinical research base of TCM .

【Objective】To observe the in-vitro effect of panax notoginseng saponins(PNS) on bone marrow mesenchymal stem cells(MSCs) proliferation and on inducing MSCs to differentiate into cardiomyogenic cells.【Methods】MSCs were isolated from adult SD rats,and then were cultured and cloned by density gradient method and adhesive cultivation.The cell surface markers of MSCs were detected with flow cytometer.The effect of PNS on MSCs proliferation was observed with methyl thiazolyl tetrazolium(MTT) assay.The 8th generation of continuous cultured MSCs was used to observe the in-vitro differentiation of cardiomyogenic cells.The cardiomyogenic cells were identified under phase contrast microscope by immunohistochemical method and reverse transcription-polymerase chain reaction(RT-PCR) analysis.【Results】CD44 expression of MSCs was positive while that of CD34 expression of bone marrow hematopoietic stem cells was negative,indicating the success of the MSCs culture.After induction with PNS,the increase of MSCs was obvious as compared with the blank control group,and there existed histological changes of MSCs after in-vitro induction.The expression of specific proteins of Desmin and cardiac troponin I(cTnI) in MSCs was positive,and the results of RT-PCR analysis showed that the expression of myosin heavy chain(MHC) was increased.【Conclusion】PNS can increase the in-vitro proliferation of MSCs and induce MSCs to differentiate into cardiomyogenic cells in vitro,and this will supply experimental evidence of cell transplantation for the treatment of myocardial infarction.

[Objective] To observe the in-vitro inductive effect of ginsenosides (GS) on differentiation of rat bone marrow mesenchymal stem cells (MSC) into myocardial cells. [Methods] Marrow stromal cells were isolated from adult SD rats, and then were cultured and cloned by density gradient method and adhesive cultivation to prepare the primary MSC. The cell surface antigens of CD34 and CD44 were detected with flow cytometer to identify MSC. After subculture, the 8th generation of continuous MSC were induced by GS (250 mg/L) and 5-aza (5-azacytidine, 10 ?mol/L) and GS + 5-aza (250mg/L and 10 ?mol/L respectively) for 24, 48 and 72 hours to differentiate to myogenic cells. Meanwhile, a blank control group was set to compare the effect. After the induction, myocardial cell percentage was worked out after examining MSC count and positive cells count under the phase contrast microscope. The specific proteins of Desmin and cardiac troponin I (cTnI) in myocardial cells were detected by immunohistochemistry method, and the cardiac-specific gene expression of ?-MHC (myosin heavy chain) and ?-MHC in myocardiocytes was examined by reverse transcription-polymerase chain reaction (RT-PCR) analysis. [Results] The cultured marrow stromal cells grew well, spindle in shape, and their CD44 expression was positive, indicating that marrow stromal cells differentiated to MSC. After induction with GS and 5-aza, MSC differentiated to myocardial cells, and the myocardial cell percentage was 38% in GS group, 35% in 5-aza group and 39% in GS + 5-aza group, the difference being insignificant. The expression of Desmin, cTnI and MHC in MSC was positive, and MSC were spindle-shaped and looked like fibroblast, indicating that MSC differentiated to myocardial cells. [Conclusion] Ginsenosides can induce MSC to differentiate to myogenic cells in-vitro, and this will supply evidence for cell transplantation.

Objective:To analyze the risk factors of acute renal injury (AKI) after coronary artery bypass grafting (CABG) in the elderly patients.Methods:A total of 423 patients aged over 60 years who underwent CABG in Linyi People′s Hospital from May 2014 to May 2010 were retrospectively analyzed. Patients were divided into AKI group and control group according to whether AKI occurred. The risk factors of AKI were analyzed by multivariate logistic regression.Results:Among the 423 patients, 62 cases(14.7%)developed postoperative acute kidney injury. Compared with the patients without AKI ( n=361), the proportions of patients with hypertension, heart function (NYHA) ≥ Ⅲ, atrial fibrillation and cardiopulmonary bypass were higher in AKI group, the proportion of patients using statins before operation was lower [71.0%(44/62) vs. 50.7%(183/361),χ 2 =8.75, P<0.01;38.77%(24/62) vs. 7.5%(27/361),χ 2 =48.67, P<0.01;16.1%(10/62) vs. 4.4%(16/361),χ 2 =12.55, P<0.01;51.6%(32/62) vs. 21.3%(77/361),χ 2 =25.37, P<0.01;59.7%(37/62) vs. 85.6%(309/361),χ 2=23.87, P<0.01]. Patients in AKI group had higher level of blood uric acid, urea nitrogen and creatinine [353.8(275.5, 462.5)μmol/L vs. 314.5(262.9, 383.6)μmol/L, Z=2.75, P=0.01;5.5(4.3, 8.2)mmol/L vs. 5.1(4.3, 6.4)mmol/L, Z=2.44, P＝0.02; 74.9(58.5, 92.7)μmol/L vs. 67.0(57.1, 76.3)μmol/L, Z=2.90, P=0.01];and longer operation time, more blood loss and blood vessel bridge than those in control group [(403.2±124.1) vs. (350.6±110.2), t =3.41, P<0.01;(4.0±0.9) vs. (3.7±0.8), t=2.83, P=0.01;(3.8±0.7) vs. (3.5±0.8), t=3.58, P<0.01]. The multivariate logistic regression analysis showed that preoperative cardiac function (NYHA)≥Ⅲ( OR=8.528,95% CI:3.734-19.477, P<0.01),hypertension( OR=6.455,95% CI:2.605-15.997, P<0.01),extracorporeal circulation( OR＝3.046,95% CI:1.190-7.795, P=0.02),diabetes mellitus( OR=2.294,95% CI:1.047-5.026, P=0.04),elevated serum uric acid level( OR=1.004,95% CI:1.000-1.008, P=0.03)were the independent risk factors for AKI. Statins is a protective factor for postoperative AKI( OR=0.366,95% CI:0.154-0.873, P=0.02). Conclusions:AKI is a common complication after CABG in elderly patients. Cardiac function(NYHA) ≥ Ⅲ,hypertension,extracorporeal circulation,diabetes mellitus,elevated serum uric acid level are risk factors and administration of stating is protective factor for the incidence of acute kidney injury in elderly patients after coronary artery bypass grafting.

Objective To compare the feasibility and safety of endoscopy with laparoscopy and without for gastric stromal tumor.Methods A retrospective and comprehensive analysis was made based on the clinical data of endoscopic (53 cases) and laparoscopic (39 cases) resection for gastric stromal tumor (diameter ＜ 3 cm with clear boundary),by comparing the operation time,intraoperative blood loss,indwelling time of postoperative gastric tube,recovery time of bowel functions,postoperative complications,hospitalization time,metastasis,recurrence rate.Results Compared with the laparoscopic group,the endoscopic group required shorter operation time [50(48-58) min VS 70 (50-95) min,U =1575.00,P ＜ 0.01],less intraoperative blood loss [10 (5-15) ml VS 20 (20-30) ml,U =1794.00,P ＜ 0.01],earlier recovery of bowel functions [18 (8-36) h VS 24 (20-40) h,U =1666.00,P ＜ 0.01],hospitalization time,indwelling time of the postoperative gastric tube and postoperative complications showed no statistical difference (P ＞ 0.05).The postoperative follow-up time were (27 + 15) and (24 + 11) months in the endoscopic and laparoscopic group,respectively (t =0.3084,P ＞ 0.05).During the follow-up,no tumor recurrence or distant metastasis was discovered,nor was death of gastric stromal tumor.Conclusion Endoscopy without the assist of laparoscopy for the gastric stromal tumor,whose diameter is less than 3 cm with clear boundary,is safe and less invasive,and leads to quick recovery.

Objective To observe the effect of stress on the rapid component of delayed rectifier potassium current (IKr) in rat cardiomyocytes. Methods Forty male SD rats were randomly divided into four groups (10 each): control group (Ctrl), exhaustive group (ES), noise group (WN) and composite group (ES+WN). Stress animal models were prepared as follows: Rats in ES group were undergoing exhaustive swimming as the stress factor, in WN group undergoing white noise and in ES+WN group undergoing exhaustive swimming + white noise as the stress factor. Langendorff device was used to reversely perfuse collagenase for isolating the rat's ventricular myocytes. The effect of stress on IKr current and gating mechanism of single ventricular myocyte was recorded by whole-cell patch clamp technique. Results Compared with the Ctrl group, the tail current density of IKr (IKr,tail) of ventricular myocytes increased significantly in ES group and WN group (P<0.01). The IKr,tail current density of the ventricular myocytes in ES+WN group was significantly higher than that in ES group and WN group (P<0.01), and the effect was voltage dependent. Gating mechanism revealed that the half inactivation voltage of IKr,tail (V1/2,inact) can be shifted to the right in ES group, WN group and ES+WN group when compared with the Ctrl group, and the recovery time constant shortened after inactivation (P<0.01). However, the steady-state activation, fast inactivation constant and voltage dependence of IKr,tail were not statistically significant in ES group, WN group and ES+WN group when compared with the Ctrl group. Conclusion Stress increases the IKr current in rat cardiomyocytes, suggesting it be one of the electrophysiological bases of stress-induced arrhythmia.

AIM　To determine whether O-β -D-fructofuranosyl-〔(2→1 )-O-β-D-fructofuransyl〕4α-D-glucopyranoside (inulin-type hexasaccharide, IHS), a monomer extracted from the roots of Morinda of ficinalis How, has antidepressant action. METHODS Fo rced swimming tests in mice and rats and differential-reinforcement-of-low-r ate 72 second schedule (DRL 72 s) in rats were used. RESULTS In the forced swimming test in mice, IHS (80 mg*kg-1, po), like the effe ct of clinically effective antidepressant desipramine (10 mg*kg-1, ip)， produced significant decrease in immobility time. IHS (20 mg*kg-1，po ) also elicited significant decrease in immobility time in forced swimming test in rats, which was comparable to the effect of desipramine (40 mg*kg-1, po). Moreover, in the DRL 72 s in rats, IHS (5～10 mg*kg-1, ip), s imilar to desipramine (5 mg*kg-1, ip), elicited significant increase in reinforcers. CONCLUSION These findings demonstrate that IHS has antidepressant action and is an effective component extracted from the root s of Morinda officinalis How.

Objective:To prepare a virus-like particle (VLP),containing Hepatitis B virus core antigen (HBcAg) and N-terminal peptides of the L2 protein of human papilloma virus (HPV),and investigate the immunogenicity of the VLP in mice and the protection against different strains of HPV .Methods:A fusion gene was synthesized to insert a DNA fragment ,coding for the N-terminal epitopes of the L2 protein of HPV16,into the HBcAg coding sequence;HBc-L2 fusion protein was highly expressed in E.coli using the pET9a and BL21(DE3) expression system;the purified fusion protein was used to immunize BALB/c mice and antibody titers against the L2 epitopes in mouse sera were determined by indirect ELISA;the levels of neutralizing antibodies against both HPV 16 and 18 were also analyzed.Results:HBc-L2 fusion protein was expressed in E.coli and purified,with the purity >80%,by ammonium sulfate pre-cipitation and CL-4B gel filtration;analysis of the purified fusion protein ,using size exclusion chromatography with multi-angle laser light scattering detection ( SEC-MALS) and electron microscope ,revealed that HBc-L2 was assembled into a stable VLP structure auto-matically following its expression;immunization of BALB/c mice with the purified VLPs resulted in high antibody titers in mouse sera against the L2 epitopes;furthermore,it was demonstrated that the sera from the immunized mice had neutralization activities against both HPV16 and HPV18.Conclusion:The immunogenicity of the L2 epitopes was highly enhanced by the construction of HBc-L2 fusion protein and the formation of the VLP structure;the fusion protein was also capable of inducing protections against different serotypes of HPV,therefore,it could be a potential HPV vaccine with a broad coverage and low production cost .