Objective To study the inhibition of growth and induction of differentiation of mouse B16 melanoma by acitretin and their mechanism.Methods Animal models of B16 melanoma were established by subcutaneously inoculation of cultured B16 cells into the right axilla of mice.All mice were divided into 5 groups,negative control group treated with peanut oil,low-dose acitretin group treated with acitretin 10 mg per kilogram of body weight per day,high-dose acitretin group treated with 20 mg per kilogram body weight per day,cisplatin group treated with cisplatin 10 mg per kilogram body weight,combination group treated with acitretin 20 mg per kilogram body weight per day plus cisplatin 10 mg per kilogram body weight.Acitretin was given daily via intragastric administration.and cisplatin was given with an interval of 7 days,from day 2 till day 22 after the inoculation.The growth of transplanted tumor was measured with an interval of 3 days.After drug withdrawal,mice were killed,transplanted tumors were obtained for the measurement of tumor weight,pathological examination and immunohistochemical staining for survivin,Fas and vascular endothelial growth factor(VEGF).Results Acitretin could significantly inhibit the growth of B16 melanoma,the average weight and volume of transplanted tumor in the treated groups were significantly lower than those in the negative control group(all P＜0.01).Pathological examination revealed that in the control group,tumor cells showed typical heteromorphism,and closely arranged with an obscure boundary,whereas in the treated groups,a massive or focal necrosis at different levels was observed in the center and margin of tumor tissue.The relative expression levels of suvivin,VEGF and Fas protein were 3.600±0.966,4.600±0.966,4.300±0.949 respectively,in high-dose acitretin group,2.100±0.568,2.400±0.516,5.900±0.730 respectively,in combination group,5.900±1.370,6.100 ±1.1 97,2.1 00±0.568,respectively,in the negative control group,and a significant decrease was observed in the expression of suvivin and VEGF in the former two groups along with an increase in Fas expression compared with the negative control group(all P＜0.01).Additionally,in all the treated mice,the expression of survivin was negatively correlated to that of Fas(rs=-0.77,P＜0.01),but positively to that of VEGF (rs=0.72,P＜0.01).Conclusions Acitretin can obviously inhibit the growth and induce the differentiation of B16 melanoma,which may be associated with its downregulation of survivin and VEGF expression as well as the upregulation of Fas expression.

Objective To investigate the changes of umbilical cord and the vasoactive substance in umbilical vein in intrahepatic cholestasis of pregnancy.MethodsBy HE staining method we analyzed the pathologic change of umbilical cord of 25 women with intrahepatic cholestasis of pregnancy(ICP)and fetal distress(ICP fetal distress group),25 ICP women without fetal distress group(ICP control group)and 27 normal pregnancies(control group).The nitric oxide synthase(NOS)and endothelin-1(ET-1)were detected in human umbilical vein endothelial cells(HUVEC)by immunohistochemistry method.Umbilical vein total bile acid(TBA)and NOS and ET-1 were measured.Resuits(1)A remarkable high TBA level was found in umbilical vein in ICP,and it was higher in ICP fetal distress group(19.0±2.3)μmol/L than in ICP control group(9.0±1.7)μmol/L(P＜0.05);it was higher in ICP control group than the control group(4.4±1.5)μmol/L(P＜0.05).(2)A significant difference was found in the endotheliocytes of umbilical vein in ICP fetal distress group compared with ICP control group.The ratio of cells with pathological changes in ICP fetal distress group(92％,23/25)was higher than ICP control group(68％,17/25;P＜0.05).The occurrence of the pathological changes was associated with TBA.(3)The expression of eNOS in ICP fetal distress group 0.09±0.06 was lower than in ICP control group 0.21±0.08(P＜0.05),and it was lower in ICP control group than in control group 0.47±0.07(P＜0.05).In contrast.the expression of ET-1 in ICP fetal distress group 0.49±0.08 was higher than in ICP control group 0.32±0.07(P＜0.05),and it was higher in ICP control group than control group 0.14±0.06(P＜0.05).The expression of inducible nitric oxide synthase(iNOS)in ICP fetal distress group 0.20±0.04 and ICP control group 0.21±0.05 was lower than in control group 0.26±0.04(P＜0.05),but no significant difference was found in ICP fetal distress group and ICP control group(P＞0.05).(4)The expression of eNOS,iNOS and ET-1 was correlated with umbilical vein TBA in ICP(r1=-0.88,r2=-0.45,r3=0.79;P＜0.01),respectively.Conclusions High level of TBA in ICP is harmful to the umbilical vein endothelium,which is correlated with the raised expression of ET-1.and the decreased expression of eNOS,and iNOS in human umbilical cord endothelium cells.All these changes of umbilical vein may be associated with the occurrence of fetal distress in ICP.

Primary lymphoma of bone (PLB) refers to non-Hodgkin lymphoma (NHL),which is an uncommon extranodal lymphoma,accounting for 1 % of all NHL,5 % of extranodal lymphoma and 7 % of primary bone tumor. Currently,the diagnostic criteria of PLB includes a primary focus in a single bone; positive histological diagnosis; and no evidence of distant soft tissue or distant lymph node involvement. The diversity,hereditery,and lower incidence of PLB make it difficult to diagnose. In order to decrease the rate of misdiagnosis and missed diagnosis,the clinical,pathological,and imaging characteristics of PLB in this study are analyzed.

Effective medical practice in the bio-psycho-social medical model calls for the doctor's narrative and communicative skills.The gradual application of narratives in medical practice and research facilitates the combination of narrative methods with medical science.The narrative medicine movement greatly promotes the narrative turn in the research of doctor-patient communication and provides a new perspective in medical humanities education.In the process of doctor-patient communication,the appropriate use of doctors' high narrative competence contributes to effective doctorpatient communication and helps to build a harmonious doctor-patient relationship.In medical education,the teaching strategy of combining classroom teaching with clinical probation teaching should be adopted to cultivate and enhance medical students' medical narrative competence.

Currently refractory and relapsed mantle cell lymphoma (MCL) continues to develope a poor prognosis, and the treatment remains a significant clinical challenge. The use of bortezomib in clinic provides a novel method for the treatment of refractory and relapsed MCL. This review summarizes the mechanism and efficiency of bortezomib in the treatment of MCL and the strategies for overcome of bortezomib resistance.

Different subtypes of chronic hepatitis B virus(HBV)infection occurred clinically because of the status of virus’s interaction with immune system. In patients with immune tolerance,high level of HBV DNA was found,serum hepatitis B e antigen(HBeAg)was positive,and serum level of alanine aminotransferase(ALT)was normal with only mild or no inflammation in liver tissue. However,not all the patients with normal ALT were in immune tolerance status,the disease could progress insidiously and develop into liver cirrhosis. Whether these patients need anti-viral therapy has always been a hotspot of study. This article reviewed the correlation between immune status and HBV infection,the identification of patients with normal ALT but not in immune tolerance status,and the indication of anti-viral therapy for these patients.

It has been nearly 20 years from the discovery of hepatitis C virus (HCV)and clinical diagnosis of hepatitis C to antiviral therapy with interferon,and significant progress has been made.Substantial changes have taken place in both the concept and strategy for antiviral treatment of hepatitis C,with more and more direct-acting antiviral agents emerging in recent years;these changes are as follows:from the control of HCV to clinical cure,from a sustained virologic response (SVR)rate around 30%with conventional interferon therapy to an SVR rate of 70%-80% with standard therapy with pegylated interferon and ribavirin,and from evaluating the difficulty of treatment based on genotypes and viral load to determining the treatment strategy according to host IL28B genotypes and response patterns (rapid virologic re-sponse and complete early virologic response).The progress in antiviral therapy strategies for hepatitis C is systematically reviewed for re-understanding of refractory hepatitis C.

OBJECTIVE:To optimize the ultrasonic-assisted extraction technology of total flavonoids from Tibetan Scindapsus aureu. METHODS:The single-factor test was adopted to investigate the effects of extraction time,extraction temperature,the vol-ume fraction of ethanol,the ratio of liquid to solid and power on the extraction rate of total flavonoids from Tibetan Scindapsus au-reu in the process of ultrasonic-assisted extraction,based on which,four-factor and five-level Box-Behnken central component de-sign was performed with unchanged ultrasonic power,and then response surface method was adopted to analyze the effects of the 4 factors and their interaction on the extraction rate of total flavonoids to determine the optimal factor and level,and verification tests were conducted.RESULTS:The optimal ultrasonic-assisted extraction technology was as follows as extraction time of 29 min,tem-perature of 44 ℃,volume fraction of ethanol of 78%,ratio of liquid to solid of 13∶1(ml/g). In three verification tests,the aver-age extraction rate of total flavonoids was 2.130%,with an relative error of 0.005% compared to the theoretical value. CONCLU-SIONS:The optimal technology is reasonable and feasible,and can be used for theultrasonic-assisted extraction of total flavonoids from Tibetan Scindapsus aureu.

BACKGROUND:Aclassical orthognathic schemefor mandibular prognathism includespreoperative cephalometric analysis,acquiring modulus, facebow transfer, modelsurgery, making occlusion plate.This process is cumbersome,complex,andproneto have bias. Moreover, orthognathic effects are difficult to be predicted, which is a majordifficultyindoctor-patientcommunication.
OBJECTIVE:To summarize and analyze the use of three-dimensional scanning techniques in the treatmentand diagnosisof mandibular prognathism, including principle, application and relative merits, thusprovidingreference forapplying to theclinic.
METHODS:Papers addressing the use of three-dimensional scanning techniques in thediagnosisand treatment of mandibular prognathism were retrieved by computer in Wanfang and PubMed databases with the key words of “three-dimensional scanning, class III,orthognathic, mandibular prognathism” in Chinese and English, respectively. A total of 48papers were included for review.
RESULTS AND CONCLUSION:Compared with the traditional technology,the three-dimensional scanning technology has high accuracy and efficiency in the diagnosis and treatment of mandibular prognathism, and candirectlycapture the 3D geometry of objects for modeling, colection and measurement of biological data, which provides a reliable monitoring method for postoperative assessment andfolow-up. Compared with the CT,thethree-dimensional scanning technology cannot show the internal structure and separate hard and soft tissues, which should be reasonably chosen according to practical data.

Objective To study the risk of pregnant women with epilepsy and its appropriate treatment. Methods A retrospective medical records review was conducted in 15 pregnant women with epilepsy at Peking Union Medical College Hospital from 1984 to 2004. The data were collected including maternal age at delivery, parity, gestational weeks at delivery, types of epilepsy, occurrence of seizures during trimester,mode of delivery and neonatal outcome. Results The prevalence of pregnancy with epilepsy was 0.06%. Six cases(40%)were aged 20～29, and 9 (60%) aged 30～36. There were 14 primigravidas, and 1 multiparity. One case delivered before 37 weeks and 14 after 37 weeks. The onset of epilepsy occurred before the age of 20 in 66.7% of women. During pregnancy, the number of occurrence of seizures increased in 5 patients (33.3%), decreased in 1 patient(6.7%), 9 cases(60%)were the same to non-pregnant period and 7 cases(46.7%)had no seizures. Ten women(66.7%) were on mono-medication, while 4 (26.7%) cases were on combined medication and 1 (6.6%) patient without medication. The Apgar′s score of all children was 10 at delivery and no congenital malformation was found. Two cases had breast-feeding postpartum. Conclusions Women with epilepsy should have prepregnant counseling. The lowest dose of antiepileptic drug (AED) and folic acid supplementation should be recommended before anticipated conception. During trimester, the blood concentration of AED should be closely monitored in order to adjust the dose. The prenatal outcome will be improved with proper management.