Objective To determine the cerebral protective effect of different concentrations of desflurane anesthesia during craniotomy.Methods Twenty two patients, scheduled for selective craniotomy for resections of supratentorial mass lesions, were anesthetized by inhalation of desflurane. When the concentrations of desflurane were maintained at 0.7,1.0 and 1.3 mean alveolar concentration (MAC) for 30 min during removing the tumor, venous blood samples which were drawn through internal jugular bulb were analyzed. Mean arterial pressure (MAP), heart rate (HR), and jugular bulb pressure (JBP) were recorded during the craniotomy.Results Jugular bulb oxygen saturation (SjO2) was significantly declined at 1.0 and 1.3 MAC compared with that at 0.7 MAC (P<0.05 and P<0.01 respectively). There was no significant changes in SjO2 between 1.0 and 1.3 MAC (P>0.05). MAP declined dose dependently, and decreased more significantly at 1.3 MAC (P<0.01).HR and JBP increased slightly with the raising concentration of desflurane but there were no significant changes at any MAC of desflurane (P>0.05).Conclusion Desflurane anesthesia at 1.0 MAC shows cerebral protection effect during craniotomy with stable hemodynamics and improved cerebral oxygen supply and demand.

ObjectiveTo compare the effects of normal saline (NS), 10% hydroxyethyl starch (HES) and hypertonic-hyperoncotic solution (HHS,7.5% NaCl/10% HES) on regional cerebral blood flow (rCBF), brain edema and blood-brain barrier (BBB) in a rat model of traumatic head injury (THI) complicate with hemorrhagic shock. Methods60 SD rats were randomized into 5 groups: sham group (n=12), model group (n=12), NS group (n=12), HES group (n=12) and HHS group (n=12). rCBF and mean arterial pressure (MAP) were determined before and after THI, hemorrhagic shock and resuscitation. Cerebral water content and Evans Blue (EB) content were assessed 3 h after resuscitation.ResultsMAP and rCBF were restored to baseline values immediately after resuscitation in all resuscitated group and began to decrease 15 min, 30 min or 45 min later, respectively(P<0.05). 3 h after resuscitation, the brain water content was higher in NS group than those in sham or HHS group(P<0.05). EB contents of injured hemispheres were higher in model and NS group than those in HES or HHS group(P<0.05). ConclusionSmall-volume resuscitation with HHS can restore MAP and rCBF, decrease brain edema and improve BBB in a rat model of THI complicate with hemorrhagic shock.

OBJECTIVETo investigate the effects and regulatory mechanism of ILK on angiogenesis in hypertrophic scar.

METHODSThe human scar microvascular endothelial cells (HSMECs) were isolated from 6 patients' hypertrophic scar in vitro. The HSMECs with good condition in 2nd to 4th generation were selected as experimental objectives. (1) HSMECs were divided into the blank control group (treated with routine culture), negative control group (treated with only Lipofectamine 2000), LY294002 group (incubated with 50 nmol/L LY294002), ILK siRNA group (incubated with 20 nmol/L ILK siRNA). RT-PCR and Western Blot were used to detect the expression of ILK mRNA and its protein after transfecion for 48 h. (2) The digested HSMECs of four groups were resuspended with DMEM without serum and then seeded onto the upper compartment of transwell insert which contained complete medium in its lower compartment. The cell migration experiment was stopped in 10 h and then the migrated cells were counted to analyze the effects of different interventions on the migration ability of HSMECs. (3) The thawed ECMatrix was put into each well of pre-colled 48-well tissue culture plate, and then the plate was put into the incubator at 37 degrees C to make it to become gel. The HSMECs of four groups were seeded onto the surface of the ECMatrix gel and were put into incubator. Eight random view-fields per well should be valued by the sheet of pattern recognition about angiogenesis after 8 hours to evaluate the ability of angiogenesis in vitro between four groups.

RESULTS(1) The expression of ILK mRNA (ILK mRNA = 0.829 +/- 0.109, t = 13.151, P = 0.006) and protein (ILK protein = 0.096 +/- 0.049, t = 36.656, P = 0.000) were both inhibited obviously in ILK siRNA group compared with the blank control group (ILK mRNA = 0.829 +/- 0.109, ILK protein = 1). And, the expression of ILK in LY294002 group was slightly lower than that of black control group, but there was no statistical difference. (2) The number of migrated cells in ILK siRNA group (88.111 +/- 3.079) and LY294002 group (138. 667 +/- 2.404) were respectively lower than that in blank control group (322.333 +/- 3.712, P < 0. 05) in 10th hour. (3) Compared to blank control group (4.333 +/- 0.191), the ability of angiogenesis in vitro decreased significantly ILK siRNA group (2.625 +/- 0.125) and LY294002 group (3.125 +/- 0.250), in which, the vascular network structures were not formed perfectly in 8th hour (P < 0.05).

CONCLUSIONSThe ability of HSMECs' migration and angiogenesis in vitro are inhibited significantly when the expression of ILK is down-regulated. It reveals that ILK may play an role in the regulation of scar angiogenesis.

Cell Movement ; Cell Proliferation ; Chromones ; pharmacology ; Cicatrix, Hypertrophic ; enzymology ; pathology ; Endothelial Cells ; cytology ; drug effects ; Humans ; Lipids ; pharmacology ; Morpholines ; pharmacology ; Neovascularization, Pathologic ; etiology ; pathology ; Protein-Serine-Threonine Kinases ; genetics ; physiology ; RNA, Messenger ; analysis ; RNA, Small Interfering ; metabolism

With the diversion rate of ginkgolide A, B, K as comprehensive evaluation indexes, the amount of activated carbon, ad- sorption time, mix rate, and adsorption temperature were selected as factors, orthogonal design which based on the evaluation method of information entropy was used to optimize activated carbon adsorption technology of ginkgo diterpene lactones meglumine injection. Opti- mized adsorption conditions were as follows: adsorbed 30 min with 0.2% activated carbon in 25 °C, 40 r ·min⁻¹, validation test re- sult display. The optimum extraction condition was stable and feasible, it will provide a basis for ginkgo diterpene lactone meglumine injection' activated carbon adsorption process.
Adsorption ; Charcoal ; chemistry ; Chemistry, Pharmaceutical ; instrumentation ; methods ; Diterpenes ; chemistry ; isolation & purification ; Drugs, Chinese Herbal ; chemistry ; isolation & purification ; Ginkgo biloba ; chemistry ; Lactones ; chemistry ; isolation & purification

Objective To explore the effect of group mind-games and group counseling on training burnout among soldiers who quickly marched to the plateau for the first time .Methods Totally 399 soldiers who quickly marched to the plateau for the first time were divided randomly into to the control group ( n=201 ) and test group ( n=198 ) .The test group had particinated in group mind-games and psychological counseling twice a week for a total of 5 weeks, while the control group received no counseling .Soldier training fatigue questionnairs were used to compare the difference between the two groups before and after group mind-games and psychological counseling .Results ①The total scores of training burnout and the scores of all the factors of soldiers before counseling in the two groups was of no statistical significance (P>0.05). After counseling , the total scores of training burnout and the scores of all factors in test group were remarkably lower than those in control group,and the difference was of statistical significance (P<0.05).The total scores of training burnout and the scores of physical and psychologica exhaustion and alienaties decreased significantly after training in test group ( P<0.05), but the change was of no statistical significance in control group (P>0.05).②Soldiers who had served 1 to 2 years or over 9 years had significant difference in the scores of training burnout , physical and psychologica exhaustion ( P<0.05).Soldiers who had served 3 to 8 years had significant difference in the scores of training and the scores of each factor after counseling(P<0.05).Conclusion Group mind-games and psychological counseling can effectively help alleviate the training burnout of soldiers who quickly march to the plateau for the first time.

OBJECTIVETo explore the inhibitory effects of endoplasmic reticulum-retained intrabody on the secretion of type IV collagenase and the invasion of human pulmonary giant cell carcinoma PG cells in vitro.

METHODSTwo expression plasmids were constructed, pcDNA3.1-CP.scFv and pcDNA3.1-ER.scFv encoding cytoplasm-retained and endoplasmic reticulum-retained single chain antibodies against the type IV collagenase, respectively. The intracellular antibody genes were transfected into the human pulmonary giant cell carcinoma PG cells. Western blot was performed to detect the expression of pcDNA3.1-CP.scFv and pcDNA3.1-ER.scFv. Gelatin zymography was performed to detect seretion of type IV collagenase in PG cells and Matrigel assay was employed for determination of the cell invasiveness.

RESULTSBoth of cytoplasm-retained and endoplasmic reticulum-retained introbodies, CP.scFv and ER.scFv, were expressed in PG cells. ER.scFv, significantly inhibited the secretion of type IV collegenase. As shown, matrix metalloproteinase 9 and matrix metalloproteinase 2 were inhibited by 85.7% and by 51.2%, respectively. However, CP.scFv did not show such inhibitory effect. The ER.scFv encoding gene-transfected PG cells were much less invasive than parental or vector control cells, the inhibition rate was 76.3% (P < 0.05), whereas CP.scFv encoding gene-transfected PG cells showed no reduction in invasiveness.

CONCLUSIONThose findings demonstrate that endoplasmic reticulum (ER)-retained intracellular antibody technology may selectively abrogate the activity of type IV collagenase in the protein trafficking and secretory pathway and effectively inhibit tumor cell invasion in vitro. Anti-type IV collagenase intrabody may be further used in cancer gene therapy.

Carcinoma, Giant Cell ; metabolism ; pathology ; Cell Line, Tumor ; Cytoplasm ; immunology ; Endoplasmic Reticulum ; immunology ; Genetic Vectors ; Humans ; Immunoglobulin Variable Region ; metabolism ; physiology ; Lung Neoplasms ; metabolism ; pathology ; Matrix Metalloproteinase 2 ; immunology ; metabolism ; Matrix Metalloproteinase 9 ; immunology ; metabolism ; Neoplasm Invasiveness ; Plasmids ; Transfection

BACKGROUNDThe difference between renal oncocytomas (RO) and renal clear cell carcinomas (RCCs) presents the greatest diagnostic challenge. The aim of this study was to retrospectively determine if RO and RCCs could be differentiated on computed tomography (CT) images on the basis of their enhancement patterns with a new enhancement correcting method.

METHODSForty-six patients with a solitary renal mass who underwent total or partial nephrectomy were included in this study. Fourteen of those were RO and 32 were RCCs. All patients were examined with contrast-enhanced CT. The pattern and degree of enhancement were evaluated. We selected the area that demonstrated the greatest degree of enhancement of the renal lesion in the corticomedullary nephrographic and excretory phase images. Regions of interest (ROI) were also placed in adjacent normal renal cortex for normalization. We used the values of the normal renal cortex that were measured at the same time as divisors. The ratios of lesion-to-renal cortex enhancement were calculated for all three phases. The Student's t-test and Pearson's Chi-square test were used for statistical analyses.

RESULTSAll RCCs masses showed contrast that appeared to be better enhanced than RO on all contrast-enhanced phases of CT imaging, but there was no significant difference in absolute attenuation values between these two diseases (P > 0.05). The ratio of lesion-to-cortex attenuation in the corticomedullary phase showed significantly different values between RO and RCCs. The degree of contrast enhancement in RCCs was equal to or greater than that of the normal renal cortex, but it was less than that of the normal cortex in RO in the corticomedullary phase. The ratio of lesion-to-cortex attenuation in the corticomedullary phase was higher than the cut off value of 1.0 in most RCCs (84%, 27/32) and lower than 1.0 in most RO (93%, 13/14) (P < 0.05). In the nephrographic phase, the ratio of lesion-to-cortex attenuation was higher than that in the corticomedullary phase in most RO (71%, 10/14), showing a prolonged enhancement pattern; and was lower than that in most RCCs (97%, 31/32), showing an early washout pattern (P < 0.05). In the differentiation of RO from RCCs, the sensitivity was 93%, specificity 84%, positive predictive value 72%, negative predictive value 84%, and accuracy for RO was 87, if the ratio of lesion-to-cortex attenuation in a cortex phase was lower than the cutoff value of 1.0. The sensitivity was 71%, specificity was 97%, positive predictive value was 91%, negative predictive value was 91%, and accuracy for RO was 89%, if the ratio of lesion-to-cortex attenuation in nephrographic phase was higher than that in the corticomedullary phase.

CONCLUSIONSThe ratios of renal lesion-to-cortex attenuation ratios may be helpful in differentiating RO from RCCs.

Adenoma, Oxyphilic ; diagnosis ; diagnostic imaging ; Adult ; Aged ; Carcinoma, Renal Cell ; diagnosis ; diagnostic imaging ; Female ; Humans ; Kidney Neoplasms ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

In China, there are three basic clinical decision-making modes for patients, namely patients' autonomous decision-making mode, family decision-making mode and patient and family codetermination. They were produced under the unique background of Chinese medicine, Confucian philosophy and law in China. In this paper, the concepts, advantages and disadvantages of these three decision-making modes were analyzed. In addition, some suggestions were put forward for the improvement. The first is that we suggest to establish standards for choosing decision-making modes; the second is to further learn and publicize relevant laws; thirdly, the legal system needs to be further refined; and the last one is to carry out ethical ward round.
China ; Decision Making ; Humans ; Patient Participation

The Chinese medical ethics committee and the ethical review system have made the following achievements: (1) enabled the institutionalization of medical ethics, (2) carried out the ethics review of Chinese medicine (CM) and integrative medicine extensively, (3) trained a large number of ethical professionals, (4) supported and protected the interests of patients and subjects, and (5) ensured the correct direction of biological research and provided ethical defense for the publication of its results. However, at the same time, they are also faced with some new problems and difficulties that need to be resolved in the following ways: (1) to refine the relevant rules of ethical review, (2) to develop the relevant standards of the CM and integrative medicine ethical review, (3) to enhance the independence and authority of ethics committee, (4) to emphasize innovation and to discover and solve new problems, and (5) to increase international exchanges and improve relevant research.
Ethical Review ; Ethics, Medical ; Humans ; Integrative Medicine ; Medicine, Chinese Traditional ; trends ; Patient Rights

Based on the stakeholder theory,externalities theory and marginal utility theory,this paper analyzes the behavioral needs of stakeholders in the process of market access of innovative drugs.It also draws out the core of the government and the pharmaceutical enterprises in the policy of access to innovative drug market and supply to the community,the patients,and the medical institutions enter the mechanism of the interaction of the various stakeholders in the innovative drug market for the demand community and construct the above-mentioned stakeholder perspective Innovative Drug Market Access Policy Environment Model.Based on the status quo of China's innovative drug market access,the present study puts forward to encourage innovative drug market access to the interests of the main body,to optimize the existing innovative drug market access policy environment to make reference recommendations.