Objective To observe the clinical effect and side effect of Xiaozhitang combined with western medicine .Methods Eighty male patients with hyperlipidemia in our hospital was selected from January 2010 to January 2013 and divided randomly into observation group(n=40)and control group(n=40) .Patients in the control group received treatment with atorvastatin calcium (10 mg/d)while patients in the observation group were administrated with Xiaozhitang besides the routine measures .The values of total cholesterol (TC) ,triglyceride(TG) ,high density lipoprotein cholesterol(HDL‐C)and low‐density lipoprotein cholesterol(LDL‐C) serum creatinine(Scr) ,alanine transaminase(ALT) ,aspartate aminotransferase(AST) ,creatine kinase(CK)were assessed before and after 8 ,16 weeks treatment .Drug‐induced adverse effects were also observed .Results TC ,TG ,LDL‐C were (5 .87 ± 0 .89) , (1 .62 ± 0 .62) ,(3 .62 ± 0 .55)mmol/L in the observation group before treatment and significantly reduced after 16 weeks treatment [(4 .59 ± 0 .52) ,(1 .53 ± 0 .53) ,(2 .69 ± 0 .41)mmol/L](P<0 .05) .TC ,LDL‐C were(5 .88 ± 0 .91) ,(3 .78 ± 0 .43)mmol/L in the control group before treatment and also significantly reduced after 16 weeks treatment[(5 .01 ± 0 .49) ,(2 .97 ± 0 .27)mmol/L](P<0 .05)while TG remained unchanged during 16 weeks in the control group(P>0 .05) .The observation group achieved a significantly greater reduction in LDL‐C and TC than the control group (P<0 .05) .There was a significantly differences in adverse reaction(P<0 .05)but all could be well tolerated .The quality of life score of the observation group was significantly higher than that of the con‐trol group(P<0 .05) .Conclusion The Xiaozhitang combined with atorvastatin calcium could achieve a significantly greater reduc‐tion in lipid‐lowering effect than pure western medicine ,and it shows satisfactory safety and have less side effect .

With the ventilator associated lung injury (VALI) atracting more and more attention,lung protective ventilation strategy (LPVS) has gradually been applied to clinical practice.Obese patients are at higher risk in VALI for laparoscopic surgery,mechanical ventilation induced atelectasis is an important reason for low oxygen in intraoperative and postoperativen procedure.In laparoscopic surgery,high abdominal pressure causes the elevation of diaphragm,and increases airway pressure.The excessive pressure increases the amount of alveolar dead space and airway pressure,reduces lung compliance,and increases the possibility of barotrauma and colotrauma.In addition,carbon dioxide pnenmoperitoneum indces hypercapnia.Both of them influence the recovery of postoperative lung function.To optimize intraoperative management and improve the prognosis of patients with general anesthesia,the application of LPVS attracts more attention,including small tidal volume,positive end-expiratory pressure,and recruitment maneuvers,etc.However,LVPS may also cause lung injury.This article is a review on the application of LPVS in laparoscopic surgery of obese patients.

Objective To explore the clinical curative effect of locking plate in elderly patients with proximal humeral fractures. Methods Seventy elderly patients with proximal humeral fractures were selected, and all patients were treated with surgical treatment. Among them, application of locking plate was in 35 cases (locking plate group), and application of ordinary steel plate was in 35 cases (ordinary steel plate group). The operation time, intraoperative blood loss, fracture healing time and curative effect between 2 groups were compared. Results The operation time, intraoperative blood loss and fracture healing time in locking plate group were significantly lower than those in ordinary steel plate group: (61.3 ± 5.6) min vs. (78.3 ± 4.2) min, (190.5 ± 11.5) ml vs. (268.5 ± 21.2) ml and (12.6 ± 1.8) weeks vs. (16.5 ± 1.5) weeks, the excellent and good rate was significantly higher than that in ordinary steel plate group: 94.29% (33/35) vs. 74.98% (26/35), and there were statistical differences (P<0.05). Conclusions The curative effect of locking plate in elderly patients with proximal humeral fractures is accurate. Locking plate can be fixed firmly, and it is conducive to early recovery after surgery.

The bulge of hair follicles contains a mixed population of stem cells,including epidermal stem cells,neural crest stem cells,as well as another type of stem cells which can be induced into melanocytes.Bulge stem cells have the ability to divide,proliferate and are pluripotent as other adult stem cells.The neural crest stem cells can differentiate in vitro into neurons,glia and melanocytes under proper induction.Meanwhile,it was proved that implanting these cells into the gap region of damaged nerves could greatly enhance the regeneration rate of nerve and restoration of nerve function.In this review,distribution of the stated stem cells in hair follicle bulge and their characteristics of differentiating into neurons were discussed,as well as their possible application in regenerative medicine.

Objective To evaluate the effects of preoperative sleep disturbance on the consumption of propofol during the period of general anesthesia and postoperative sleep quality.Methods Sixty-five patients scheduled for elective thyroidectomy surgery under general anesthesia were enrolled in the study.According to the preoperative Pittsburgh Sleep Quality Index (PSQI) score,the patients were divided into sleep normal group (n =33) and sleep disorder group (n =32).Anesthesia was induced and maintained with propofol given by closed-loop target-controlled infusion (CLTCI).The consumption of propofol during the period of general anesthesia,postoperative sleep quality in the evening of surgery and at 24 h after operation,and the painful levels of the patients at 1 d and 2 d after operation were compared between two groups.Results The totalconsumption of propofol in sleep disorder group [(1 024.33 ±213.02)mg] was more than that in sleep normal group [(892.25 ± 242.30) mg] (P ＜ 0.05),and the dosage of unit surface area per minute of propofol in sleep disorder group [(4.94 ± 0.80) mg/(min · m2)] was also more than that in sleep normal group [(4.45 ± 0.96) mg/(min · m2)] (P ＜ 0.05).Each group suffered from bad sleep quality in the evening of operation,and got improvement one day later (P ＜ 0.05).The sleep quality in sleep disorder group was improved after general anesthesia (P ＜ 0.05).Conclusions Preoperative sleep disturbance increased the consumption of propofol in the general anesthesia.General anesthesia can improve the sleep quality of the patients who suffered from sleep disorder.

Objective To analyze the colonization of Candida, Rhodotorula, Penicillium and Aspergillus in skin surfaces of patients with atopic dermatitis, and to assess the relationship between the four common fungal allergens and severity of atopic dermatitis. Methods Fifty patients with atopic dermatitis and 20 healthy controls were enrolled. Scales were scraped from lesional and non?lesional skin of flexural extremities of the patients, as well as from normal skin of the flexural elbow of healthy controls, then were subjected to microscopic examination and culture. Scale specimens were inoculated onto Sabouraud dextrose agar medium and cultured at 25 ℃ in a constant temperature incubator. Subsequently, suspected fungal or yeast?like colonies were collected for pure culture. Finally, fungal strains were identified according to colony morphology, color, growth speed, as well as microscopic features of spores and hyphae. Results No hyphae or pseudohyphae were found in any case by microscopic examination. Candida albicans and Rhodotorula were detected in 29(58%)and 17(34%)out of the 50 patients, respectively, and in 5(25%)and 2 (10%) out of the 20 healthy controls, respectively. The detection rates of Candida albicans and Rhodotorula were significantly higher in the patients than in the controls(χ2=6.23, 4.10, respectively, both P<0.05). Of 25 patients with severe lesions, 19(76%)and 12(48%)were colonized by Candida albicans and Rhodotorula respectively;among 25 patients with moderate lesions, 10 (40%) and 5 (20%) were colonized by Candida albicans and Rhodotorula respectively. An increase was observed in the detection rates of Candida albicans and Rhodotorula in the patients with severe lesions compared with those with moderate lesions(χ2=6.65, 4.37, respectively, both P<0.05). There was no significant difference in the detection rate of Penicillium or Aspergillus between the patients and health controls. Conclusion The colonization rates of Candida albicans and Rhodotorula on skin surfaces were higher in patients with atopic dermatitis than in healthy controls, and higher in patients with severe lesions than in patients with moderate lesions, indicating that the types of colonizing fungi are associated with the health status of skin and severity of symptoms in patients with atopic dermatitis.

Objective To establish the suspension cell line of Atractylodes lancea and to study the effect of two endophytic fungal elicitors on its essential oil production.Methods The essential oil was extracted by using ultrasonic wave after suspension cell was treated with endophytic fungal elicitors.Then,the determination of four compounds(atractylone,hinesol,?-eudesmol,and atractylodin) was carried out by gas chromatography.Results By testing in various conditions,the suspension cell line with a rapid growth rate was established.Its highest biomass(6.95 g/L) was obtained on day 21.?-Eudesmol was the only detection in the control suspension cell,and its highest content(17.469 ?g/g) was also reached on day 21.The effect of crude elicitors of two endophytic fungi(belong to Cunninghamella sp.and Gilmaniella sp.respectively,named AL4 and AL12) on the cell growth and the production of essentia1 oil were investigated.Overall AL4 elicitor got better effect.When suspension cell of 14-day-old cultures was exposed to AL4 elicitor(carbohydrate 20 mg/L medium) for 7 d,the biomass increased 3.31% over the control,and the four compounds(atractylone: 14.715 ?g/g,hinesol: 28.395 ?g/g,?-eudesmol: 38.794 ?g/g,and atractylodin: 8.310 ?g/g) were all detected.Among them,the content of ?-eudesmol reached 2.22 times as much as the control.Conclusion The cell growth and the accumulation of essential oil of A.lancea could also be promoted by adding crude elicitors of the endophytic fungi AL4 and AL12.

Objective To evaluate the effects of acitretin combined with clarithromycin on tumor growth in human oral epidermoid carcinoma xenografts in nude mice,and to investigate their antitumor mechanisms.Methods A cell line of human oral epidermoid carcinoma was subcutaneously inoculated into 31 Balb/c nude mice to establish a xenograft model of human skin tumor.Then,the nude mice were randomly classified into 6 groups according to a double blind protocol:control group (n =6) remaining untreated,placebo group (n =5) treated with wheat flour,acitretin group (n =5) treated with acitretin 7.2 mg/kg per day,clarithromycin group (n =5) treated with clarithromycin 100 mg/kg per day,acitretin + placebo group (n =5) treated with both acitretin (7.2 mg/kg per day) and wheat flour,and acitretin + clarithromycin group (n =5) treated with acitretin (7.2 mg/kg per day) and clarithromycin 100 mg/kg per day.All the drugs were intragastrically administrated once daily.After three weeks of treatment,mice were sacrificed and xenografts were removed.Then,the size and weight of xenografts were measured,and pathological analysis was conducted.Real time-PCR was performed to quantify the mRNA expressions of vascular endothelial growth factor (VEGF) and nuclear factor (NF)-κB,and immunohistochemistry was carried out to observe the expression of VEGF as well as to determine microvessel density (MVD) and Ki-67 proliferation index.By using the software SPSS 19.0,analysis of variance was performed for comparison of measurement data,and least significant difference (LSD) test for paired comparisons.Results Both the size and weight of xenografts in the acitretin + clarithromycin group were significantly lower than those in the other groups (all P ＜ 0.05).Real-time fluorescence-based PCR revealed weaker mRNA expressions of VEGF and NF-κB in the acitretin + clarithromycin group compared with the control group,clarithromycin group and acitretin group (all P ＜ 0.05).As immunohistochemistry showed,the acitretin + clarithromycin group displayed a decrease in the expression rate (all P ＜ 0.01) and staining intensity of VEGF,MVD (all P ＜ 0.01) with a sparse distribution of microvessels,Ki-67 proliferation index (all P ＜ 0.05) and proliferative activity of tumor cells compared with the control group,clarithromycin group and acitretin group.Conclusion Acitretin combined with clarithromycin can synergistically inhibit the growth of human oral epidermoid carcinoma xenografts in nude mice,downregulate VEGF expression,and suppress angiogenesis and tumor proliferation.

Objective To investigate the changes of expression of Fas-associated proteins named Fas-associated death domain protein(FADD)and death-associated protein(Daxx)in the ischemic penumbra following transient focal cerebra ischemia in rats.Methods ①Adult male Sprague-Dawley rats were randomly divided into the sham-operated group and the cerebral ischemia model group.Rats underwent right middle cerebral artery occlusion(MCAO)for 2 h and reperfusion for 1,3,6,12 and 24 h using an intraluminal suture technique.The expression of FADD and Daxx mRNA and protein were measured with methods of immunohistochemistry.Western blot and reverse transcription-polymerase chain reaction(RT- PCR)respectively were used in the ischemic penumbra of rats.②Double-label fluorescence confocal laser scanning microscopy(CLSM)was performed to monitor FADD and Daxx intracellular location before and after ischemia.Results RT-PCR,Immunohistochemistry,Western blot experiments indicated that a very low level of FADD mRNA and protein were detected in the cerebral cortex of sham rats.The expression level both of FADD mRNA and protein increased significantly at 3 h after reperfusion,peaked at 12 h,then declined markedly at 24 h in the ischemic penumbra of model rats.RT-PCR,Immunohistochemistry indicated that a relatively high level of Daxx mRNA was detected in the cerebral cotex of sham rats.The expression level of Daxx mRNA increased significantly at 3 h after reperfusion and persisted to 24 h at a high level,whose protein had a same change of expression level in the ischemic penumbra of model rats. Immunofluorescence double-staining laser scanning by CLSM showed that the immunoreactivity of FADD was located in cytoplasm,and the intracellular translocation of the immunoreactivity of Daxx from nucleus to cytoplasm was monitored by measuring the green fluorescence after ischemia.Conclusion The transient upregulation of FADD and the persistant high level of expression of Daxx may contribute to neuronal apoptosis following cerebral ischemia/reperfusion.

Objective To investigate the role of retroperitoneal lymph node dissection (RPLND) in the treatment of testicular cancer. Methods The clinical data of 39 cases (age range,20-58 years;median age,29 years) of germ cell tumor who underwent RPLND were retrospectively analyzed.Of the 39 cases,17 had the tumors on the left side and 22,on the right.One case was of seminoma,and the other 38 were of non-seminomatous germ cell tumor (NSGCT).According to the clinical examinations and radiology, 20 cases were of stage Ⅰ,15 of stage Ⅱ,and the rest 4 could not be staged. Results Of the 39 cases,10 with stage I tumors underwent nerve-sparing modified RPLND and the other 29 underwent bilateral RPLND.No metastasis was found in the dissected tissues in 22 cases,while metastasis,in 17 (including 4 of clinical stage I).All the patients with pathological metastases or elevation of blood tumor markers received postoperative chemotherapy.Follow-up was carried out for 1-149 months.The disease-free survival rate was 97.4%(38/39).Of the 10 cases receiving modified RPLND,8 regained their ejaculation function. Conclusions The probability of presence of the non-seminomatous components must be considered in the diagnosis and follow-up of seminoma cases,and the RPLND should be done if necessary.Nerve-sparing modified RPLND should be performed for clinical stage Ⅰ patients;while postoperative chemotherapy should be chosen for pathological stage Ⅱ patients.