Primary immune thrombocytopenia ( ITP) is an organ-specific autoimmune hemorrhagic disease. The etiology of ITP is still unclear, but loss of immune tolerance to platelet surface antigens is con-sidered as a fundamental cause of ITP. Therapeutic strategies that prevent the activation and proliferation of autoreactive cells have been suggested, which includes clearance of autoreactive cells ( apoptosis) , receptor editing, induction of anergy and extrinsic cellular suppression. Failure at any of these steps may lead to the production of autoantibodies against platelet and megakaryocyte glycoproteins. An improved understanding of the mechanisms for autoantibody production will provide theoretical basis for optimal diagnosis and treatment of ITP.

Objective:To evaluate the clinical effects of nicardipine for induced controlled hypotension in patients underwent orthognathic surgery.Methods:The related trails were searched from English and Chinese literature databases.The quality of the RCTs was evaluated by 2 indepandent reviewers.The data were statistical analyzed using the Rev Man 5.3.3 software.Results:5 RCTs with 248 patients were included.Meta-analysis and descriptive analysis indicated that blood loss of nicardipine group was more than that of remifentanil group [WMD =43.85,95％ CI(20.52,67.18)].There was no significant difference in blood loss between nicardipine group and dexmedetomidine group and nitroglycerin group.There was no significant difference in transfusion between nicardipine group and the control group.Nicardipine increased the heart rate during controlled hypotension and caused QT prolongation (P ＜ 0.001).Nicardipine had no adverse effects on cerebral oxygen saturation and neurophysiological function.Urinary N-acetyl-1-b-D-glucosaminidase was lower in nicardipine group than that in remifentanil group (P ＜ 0.05).Conclusion:Nicaridpine is effective in the induced controlled hypotension during orthognathic surgery,with potential renal protective effect.However,it is not better than the remifentanil on reducing the blood loss.Nicardipine can increase the heart rate and prolong the QT interval during the controlled hypotension.

Objective To investigate the clinical value of serum pepsinogen(PG)Ⅰ,Ⅱ and gastrin-17(G-17)levels in early di-agnosis for atrophic gastritis and gastric cancer.Methods The study was performed on a case-control trial,and 430 subjects were recruited.Each of them underwent endoscopy biopsies before serum tests were performed.These patients were further divided into three groups based on endoscopic and histological findings:160 non-atrophic gastritis group,118 atrophic gastri-tis group and 152 gastric cancer group.Serum samples of PGⅠ,PGⅡ and G-17 were analyzed by enzyme-linked immunosor-bent assay(ELSIA),and calculated the values of PGⅠ/PGⅡratio.Results Compared with the non-atrophic gastritis group, serum PGⅠ and G-1 7 values in atrophic gastritis and serum PGⅠ,PGⅡ,PGⅠ/PGⅡratio and G-1 7 values in gastric cancer group decreased significantly (P<0.05);compared with the atrophic gastritis group,serum PGⅠ and G-17 values in gastric cancer group decreased significantly (P<0.05).By using receiver operating characteristic curves (ROC),the cut-off points of PGⅠ84.706μg/L,PGⅡ 10.873μg/L,PGⅠ/PGⅡ ratio 11.008 and G-178.265 pg/L in atrophic gastritis group,PGⅠ65.145μg/L,PGⅡ 10.089μg/L,PGⅠ/PGⅡ ratio 6.375 and G-17 4.971 pg/L in gastric cancer group.Conclusion Low serum PGⅠ,PGⅡ,PGⅠ/PGⅡ ratio and G-1 7 values are biomarkers of atrophic gastritis and gastric cancer and valuable for the early diagnosis of gastric cancer.

Objective To study the clinical features and treatment results of hepatic epithelioid hemangioendothelioma (HEHE).Methods A retrospective study was conducted on 26 patients with HEHE who were diagnosed and treated at the Eastern Hepatobiliary Surgical Hospital in Shanghai from November 2003 to December 2015.Results The main clinical manifestations of these 26 patients included abdominal pain (13),dizziness (1),anorexia (1),the other 11 patients were asymptomatic.Ultrasound test revealed mixed echogenicity in 17 patients (17/25,68.0％).CT study showed hypointensity lesions in 10 patients (10/12,83.3％).MRI scans identified T1WI hypointense signals in 12 patients (12/14,85.7％) and T2WI hyperintense signals in 11 patients (11/14,78.6％).Platelet distribution width (PDW) assay indicated 18 patients ＜ 15.5 fl (18/22,81.8％),P ＜0.05.all the patients performed tumor makers test,including AFP,CEA,CA19-9.Slightly elevation of CA19-9 was merely identified in one patient.All the patients were confirmed CD34 positive through immunohistochemistry stains.The 1,3,5-year survival rates of these patients were 87.7％,57.0％,43.4％,respectively.Median survival was 61 months.Conclusions HEHE should be considered based on the suggestive imaging findings for the patients with negative tumor markers after exclusion of hemangioma.PDW assay may have a key role in HEHE diagnosis.

To investigate the chemical constituents of the roots of Aconitum taipaicum, silica gel column chromatography was used for the isolation and purification of compounds. A new norditerpenoid alkaloid, isodelelatine (1), along with five known alkaloids, atisine (2), delfissinol (3), liangshanine(4), hypaconitine (5) and delelatine (6) were isolated and identified. The structure of the new compound was elucidated on the basis of spectral data.

Objective To explore the therapeutic effects an d the appropriate treating time of the artificial liver support system through obs ervation and analysis of the changes of the liver function indexes before and af ter the treatment of the artificial liver support system. Methods The changes of BIL-T, BIL-D, ALT, AST, ALP, TBA, ALB, GLB, A/G of the liver fu nction indexes in a total of 38 cases with serious hepatitis treated by artifici al liver support system were observed. Besides, the dynamic changes of the BIL- T, ALT of one case of middle stage and late stage serious type hepatitis respect ively before and after the artificial liver treatment several times were observe d. Results The BIL-T, BIL-D, ALT, AST, ALP of the liver func tion indexes after the artificial liver support system treatment showed remarkab le decline, significant differences existed before and after the treatment (P

Objective To study the anti-tumor effect of Zhongjiefeng Injection in vitro and its combination with adriamycin.Methods MTT assay was adopted to determine the in-vitro anti-tumor effect,IC50 was used to measure the direct anti-tumor effect,and Jing' s formula was applied to analyze the combination of the drugs.Results Zhongjiefeng Injection can inhibit the proliferation of Bel 7402(human hepatoma cells),HCT-8(human colon cancer cells),and the IC50 was 33.13 mg/mL for Bel 7402 and 52.39 mg/mL for HCT-8 respectively.Zhongjiefeng Injection at the concentrations of 3.125,6.25,12.5 mg/mL showed an efficancy potentiation action with doxorubicin on the inhibition of HCT-8 cells in vitro,and 25,50 mg/mL showed a synergic effect on HCT-8 .Conclusion Zhongjiefeng Injection has a certain in-vitro inhibitory effect on the growth of Bel 7402 and HCT-8,its combination with doxorubicin in vitro can produce synergic effects(a simple combined or enhanced effects)to HCT-8 cells,especially high concentrations of Zhongjiefeng Injection with doxorubicin.It is suggested that Zhongjiefeng Injection in the doubled dosage may have a better synergistic effect with doxorubicin in clinical treatment of colon cancer.

AIM To establish the methods for assaying the activities of tolbutamide hydroxylase (CYP2C8/9) and chlorzoxazone 6-hydroxylase(CYP2E1) from adult human livers microsomes. METHODS The microsomes was isolated from human adults liver and the contents of microsomal protein were determined. Using the tolbutamide and chlorzoxazone as substrates, the amount of hydroxytoblbutamide and hydroxychlorzoxazone formed during the incubation period was quantified by extroppolating from the standard curve and the specific activity of CYP2C8/9 and CYP2E1 were calculated. RESULTS There was no siginificant influence on the activities of CYP2C8/9 and CYP2E1 in different times. CONCLUSIONS The methods utilized to estimate the activity of CYP2C8/9 and CYP2E1 were simple, stable, and repeatable. These methods can be used in new drug screening, safety evaluation and reseasch on pathology and toxicology of liver.

Objective To evalute the accuracy of stroke volume variation (SVV) in monitoring blood volume in patients undergoing off-pump coronary artery bypass grafting.Methods Twenty-one ASA Ⅱ or Ⅲ patients of both sexes aged 44-77 yr undergoing off-pump coronary artery bypass grafting were enrolled in this study.Anesthesia was induced with midazolam,etomidate,fentanyl,rocuronium and dolicaine and maintained with target-controlled infusion of propofol,infusion of remifentanil,intermittent iv injetion of atracurium and inhalation of sevoflurane.The patients were mechanically ventilated (VT 8 ml/kg,RR 12 bpm,I:E 1:2,PEEP 0,FiO2 80％ ).PEr CO2 was maintained at 35-44 mm Hg.Radial artery was cannulated and connected to FloTrac pressure transducer and Vigileo monitor.6％ hydroxyethyl starch 130/0.4 sodium chloride solution 7 ml/kg was infused at a rate of 0.25 ml· kg- 1 1· min- 1 at 5 min of haemodynamics stabilization after pericardiotomy (T1).HR,MAP,CVP,systemic vascular resistance (SVR),systemic vascular nesistance index (SVRI),SVV,stroke volume index (SVI)and CI were recorded at T1 and at 10 min after loading dose (T2).The change rate of HR(△HR),MAP(△MAP),CVP(△CVP),SVR(△SVR),SVV(△SVV),SVI(△SVI) and CI(△CI) were calculated.△SVI≥25％ was considered effective volume expansion.The ROC curves for HR,MAP,CVP,SVR and SVV in determining the volume expansion efficacy were plotted.The area under the curves and 95 ％ confidence interval were calculated.Results Compared with T1,CVP,SVI,CO and CI were significantly increased,SVRI and SVV decreased at T2 (P ＜ 0.01).There was no significant difference in MAP and HR between T1 and T2(P ＞0.05).△SVI was negatively correlated with △HR and △SVR ( r =- 0.737,r =- 0.480,P ＜ 0.05).△SVI was not correlated with △CVP,△MAP and( P ＞ 0.05).The change in SVI was determined by SVV 8.8％ (sensitivity =52.6％,specificity =100.0％ ).The area under the curve for SVV and 95％ confidence interval were 0.579(0.346-0.812).Conclusion SVV can not be used to accuratelymonitor the changes in blood volume in patients undergoing off-pump coronary artery bypass grafting.

Objective To investigate the correlation between 28-day prognosis and red cell distribution width (RDW) in sepsis patients.Methods This was a prospective observational study.Two hundred and thirteen sepsis patients were consecutively selected,and the patients were divided into 2 groups according to RDW:normal RDW group (RDW ＜ 0.15,160 cases) and high RDW group (RDW≥0.15,53 cases).The general conditions,acute physiology and chronic health evaluation (APACHE) 1Ⅱ score,sequential organ failure assessment (SOFA),hypersensitive C reactive protein (hs-CRP),procalcitonin (PCT),arterial blood lactic acid,liver function injury,renal function injury and 28-day mortality were compared between 2 groups.The independent risk factors of 28-day prognosis were analyzed by multifactor Logistic regression analysis.Kaplan-Meier survival analysis was used to draw the 28-day survival curve,and the survival rate was compared between 2 groups by log-rank test.Results The 28-day mortality in high RDW group (35.8％,19/53) was significantly higher than that in normal RDW group (17.5％,28/160),and there was statistical difference (P =0.007).RDW ≥0.15 was the independent risk factor of 28-day death in sepsis patients (OR =2.634,95％ CI 1.316-5.273,P =0.006).After adjusted by gender,age and other relative factors,RDW≥0.15 was the independent risk factor of 28-day death in sepsis patients (OR =2.895,95％ CI 1.155-7.252,P =0.023).The 28-day accumulative survival rate in high RDW group was significantly lower than that in normal RDW group (50.5％ vs.63.0％),and there was statistical difference (P =0.014).Conclusion The high RDW in sepsis patients is the independent risk factor of 28-day death,and RDW ≥0.15 shows an important predictive value in the prognosis of sepsis patients.