Objective To explore the treatment effect and application value of ultrasonic guided mammotome minimally invasive whirling surgery and open surgery for benign breast tumor.Methods 264 patients with benign breast diseases were randomly divided into observation group and control group,132 cases in each group.The control group took open surgery,the observation group used mammotome minimally invasive surgery,rotary cutting system.Recorded clinical surgery treatment of the two groups.Results The operating time,intraoperative blood loss,operation scar size of the observation group were (18.27 ± 3.05) min,(10.86 ± 1.69) mL,(2.76 ± 0.85) mm respectively,those of the control group were (53.48 ± 6.17) min,(97.54 ± 14.28) mL,(27.63 ± 4.31) mm respectively,the differences between the two groups were statistically significant (t =58.7753,69.2560,65.0429,all P ＜ 0.05).In the observation group,breast deformation in 0 case,postoperative occurrence skin pigmentation in 1 case,itchy skin in 2 cases,with lateral swelling in 1 case,the patients' satisfaction score was (93.42 ± 3.89) points.In the control group,breast deformation in 5 cases,postoperative occurrence skin pigmentation in 8 cases,skin itching in 9 cases,lateral swelling in 7 cases,the patients' satisfaction score was (88.16 ± 1.45) points,the differences between the two groups were statistically significant(x2 =5.096,5.636,4.648,4.604,t =14.557,all P ＜0.05).Conclusion Using ultrasonic guided mammotome minimally invasive rotary surgical treatment for benign breast diseases can shorten the operation time,reduce intraoperative bleeding,reduce the incidence of postoperative complications,patients' satisfaction is higher,and it is worthy of popularization and application in clinic.

Objective To study the characteristics of the wounded injured from of a strong and spiraling up wind of tornado blowing in Yancheng on 23 June 2006.Methods The clinical data of 144 inpatients within 36 h after tornado disaster were collected and analyzed,including gender,age,time of visiting hospital,causes of injury,injury site,injury severity score,et al.Microsoft Excel for data input and SPSS 20.0 for statistical analysis were used.Results The majority of the patients with injury was over 60 years old (57.6％).The two peak periods for accepting patients were during the 6 h ～8 h (n =55) and the 21 h ～ 22 h (n =27) after tornado disaster.The patients during the first peak period had the higher injury severity score than that during the second peak period [(18.21 ± 7.13) vs.(14.65 ±4.86),P ＜ 0.05)].The most common causes of injuries for survivors were being hit by flying/falling object blown by the wind of tornado.The common kinds of injuries were soft-tissue (24.48％),chest (20.30％),head (17.61％),lower limb/pelvis (13.73％),upper limb (8.06％),spine (7.76％).And 41.0％,17.4％ and 13.9％ of patients were admitted to department of orthopedic,department of chest surgery and department of neurosurgery,respectively.Conclusions The destructive force of tornado was very strong leading to a large number of casualties.Therefore,medical aid agencies should have to develop a appropriate treatment process to improve their emergency response capabilities and rescue capacity.

Objective To investigate the protective effects of esmolol on peritoneal macrophages in rats with sepsis.Methods Rat peritoneal macrophages were deprived of serum and divided into four groups,namely normal group,LPS stimulated group,esmolol group and LPS plus esmolol group.Quantitative real-time PCR and Western blot were performed to assay the expressions and protein levels of TNF-α,β1-AR and p65.The activation of NF-κB was determined by electrophoretic mobility shift assay.Results The expression of TNF-α mRNA and protein level was significantly increased in LPS-treated group than those in normal group (P ＜ 0.01),and those in LPS plus esmolol group was significantly lower than those in LPS stimulated group (P ＜ 0.01).The expression of β1-AR mRNA and protein level were significantly higher in LPS-treated group than those in normal group (P ＜ 0.01),The expression of β1-AR mRNA and protein level in the esmolol group was lower than those in normal group (P ＜ 0.01),and those in LPS plus esmolol group was lower than those in LPS stimulated group (P ＜ 0.01).Besides,compared with the normal group,the expression of p65 mRNA in the LPS stimulated group was noticeably higher (P ＜ 0.01).The expression of P65 mRNA in LPS plus esmolol group was significantly lower than that in LPS-treated group (P ＜ 0.01).The NF-κB/DNA binding force in the LPS stimulated group was significantly higher than that in normal group (P ＜0.01).Compared with the LPS stimulated group,the NF-κB/DNA binding force in the LPS plus esmolol group was significantly lower (P ＜ 0.01).Conclusions The expression of TNF-α mRNA induced by LPS was decreased by esmolol in rat peritoneal macrophages which might be achieved via inhibiting NF-κB pathway by the modulation role of β1 adrenergic receptor.

Objective To explore the effect of corilagin on proliferation of glioma U251 cells and glioma stem cells and IκB-α and nuclear factor (NF)-κB P65 protein expressions in these cells.Methods The glioma stem cells were isolated from glioma U251 cells by using immune magnetic beads.The cells were intervened by different corilagin concentrations (0,25,50 and 100 μg/mL) for 48 h,respectively.Cell morphology changes were observed by microscope;cell counting kit (CCK)-8 assay was used to detect the cell proliferation;dual-luciferase reporter assay was employed to detect the P65 gene promoter expression;Western blotting was used to investigate the protein expressions of Iκ B-α in cytoplasm and NF-κB P65 in nucleus.Results (1) Cell morphology observation results showed that the cells became shrunken,cell density was decreased,and cell structure was destroyed with a great deal of cell debris.(2) CCK-8 assay results showed that as compared with those in the 0 μg/mL corilagin group,the survival rates ofU251 glioma cells and glioma stem cells were significantly decreased in the 25,50 and 100 μg/mL corilagin groups (P＜0.05);while in the presence of the same corilagin concentration,the survival rate of U251 glioma cells was significantly higher than that of glioma stem cells (P＜0.05).(3) Dual-luciferase reporter assay results showed that as compared with the 0μg/mL group,the P65 gene promoter expressions of U251 glioma cells and glioma stem cells in the 25 μg/mL corilagin group were significantly increased (P＜0.05),but with increasing concentrations of corilagin,the expressions were gradually decreased.(4) Western blotting results showed that the IκB-α expressions in cytoplasm of U251 cells and U251 stem cells were significantly increased,but the NF-κB P65 expression in nucleus of U251 cells and U251 stem cells was significantly decreased with increasing concentrations of corilagin (0,25,50 and 100 μg/mL),with signficant differences between each two groups (P＜0.05).Conclusion Corilagin could inhibit the expression of P65 gene promoter,promote the IκB-α protein expression in cytoplasm,reduce NF-κB P65 protein into the nucleus,thereby to inhibit the NF-κB signaling pathway,and it is likely to be one of the important mechanisms to inhibit the proliferation of glioma cells and glioma stem cells.

Objective:To evaluate the effects of comprehensive reform of clinical education on cultivating the clinical thinking ability of medical students in internal medicine.Methods:A total of 44 clinical interns on medicine rotation were included in this study and divided into experimental group and control group, and a series of measures for clinical teaching reform, which included undergraduate tutorial system, team-based learning (TBL) mode, combination of electronic medical record and handwritten medical record, as well as formative assessment, were applied to fully promote clinical thinking ability of medical students. SPSS 17.0 software was used to compare the scores of final academic tests of rotation and competition of medical record writing between the control and the experiment groups. Self-designed questionnaires on undergraduate tutors and clinical interns were applied to comprehensively evaluate the effects of this education reform.Results:Independent-sample t tests showed there were statistically significant difference ( P<0.01) in the scores of final academic tests of rotation and competition of medical record writing between the two groups, and the mean score of the experiment group was higher than that of the control group. Questionnaire survey showed that tutors and clinical interns both fully affirmed the positive effects of the education reform on cultivating clinical thinking ability of medical students in internal medicine. Conclusion:Application of comprehensive education reform in clinical teaching of internal medicine, which based on introduction of undergraduate tutorial system and TBL mode, could effectively promote the clinical thinking ability of medical students and the teaching quality.

OBJECTIVE To investigate the effect of raw and wine-processed Schisandra chinensis on neuro-immune-endocrine network in insomnia mice and its mechanism. METHODS Fifty mice were randomly divided into blank group， model group， diazepam group， raw S. chinensis group and wine-processed S. chinensis group， with 10 mice in each group. Except for blank group， the mice in the other groups were intraperitoneally injected with thyroxine solution to establish mice model of insomnia； at the end of each day’s modeling， the corresponding doses of diazepam，raw and wine-processed S. chinensis were given by gavage. The blank group and model group were given constant volume of normal saline. The general state of the mice was observed and recorded， and the total activity distance and upright times of the mice were detected； the EEG and EMG signals of mice were recorded， and the time ratio of sleep wake time （wake）， non-rapid eye movement （NREM） and rapid eye movement （REM） was analyzed； the contents of neurotransmitters [γ-aminobutyric acid （GABA）， 5-hydroxytryptamine （5-HT）， dopamine （DA）， norepinephrine （NE）， cortisol （CORT）] in brain suprachiasmatic nucleus （SCN） were detected； and the expressions of tumor necrosis factor α （TNF-α） and interleukin 1β （IL-1β） were detected； the mRNA expressions of clock gene Bmal1， circadian clock gene Clock and cycle gene Per2 were all detected. RESULTS Compared with the blank group， the mental state of the model group mice was relatively depressed， the amount of food and water increased， the body mass decreased， the hair was rough and shiny， and the circadian rhythm was irregular； the total activity distance and upright times decreased significantly； the time ratio of wake increased significantly， while the time ratios of REM and NREM decreased significantly； the content of 5- HT in brain SCN decreased significantly， while the content of NE， DA and CORT increased significantly； the fluorescence intensity of IL-1β and TNF-α was significantly increased； the relative expression level of Bmal1 and Clock mRNA was significantly increased， while the relative expression level of Per2 mRNA was significantly decreased （P＜0.05 or P＜0.01）. Compared with the model group， the general state of mice in diazepam group， raw S. chinensis group and wine-processed S. chinensis group was improved obviously， and most of the above index levels were significantly reversed （P＜0.05 or P＜0.01）. CONCLUSIONS Raw and wine-processed S. chinensis have a certain therapeutic effect on insomnia mice， the mechanism of which may be related to the regulation of neuro-endocrine-immune system related biological indicators in insomnia mice.

ObjectiveTo explore the compatibility advantage of Scutellariae Radix-Coptidis Rhizoma in the prevention and treatment of neuroinflammation， and to elucidate the action characteristics and mechanism of the compatibility advantage based on Toll like receptor （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor kappaB （NF-κB） pathway. MethodRepresentative mouse microglia cells （BV2） in vitro were selected and divided into 8 groups： control group， model group， Scutellariae Radix-Coptidis Rhizoma group， Piracetam group， Scutellariae Radix group and Coptidis Rhizoma group. The BV2 cell inflammatory model was established by lipopolysaccharide （LPS）， and the cell activity was detected by cell counting kit-8 （CCK-8）. Cell morphology was observed under bright field. The production and release of pro-inflammatory factors in BV2 cells were determined by enzyme-linked immunosorbent assay （ELISA） and immunofluorescence assay， and the mRNA expressions of TLR4， MyD88 and NF-κB were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The nuclear translocation of NF-κB p65 was detected by immunofluorescence， and TLR4 signal transduction inhibitor （CLI-095） and NF-κB inhibitor （PDTC） were used to confirm the anti-neuroinflammation targets of Scutellariae Radix-Coptidis Rhizoma. ResultCompared with the conditions in the control group， most cells in LPS-induced model group were activated， and the contents of IL-6， TNF-α and IL-1β in culture medium and cells and the mRNA expressions of TLR4， MyD88， NF-κB p50 and NF-κB p65 were increased （P<0.01）， with obvious nuclear entry of NF-κB p65. Compared with the conditions in the model group， BV2 cell morphology was mostly recovered after pretreatment in Scutellariae Radix-Coptidis Rhizoma and Piracetam groups， and the levels of IL-6， TNF-α and IL-1β and the mRNA expressions of TLR4， MyD88， NF-κB p50 and NF-κB p65 were decreased （P<0.05， P<0.01）， with NF-κB p65 mostly observed in cytoplasm. Compared with the conditions in the model group， cell morphology was slightly recovered in Scutellariae Radix group and Coptidis Rhizoma group， and the levels of pro-inflammatory factors and mRNA expressions of TLR4， MyD88， NF-κB p50 and NF-κB p65 were reduced. In terms of inhibitory effect on pro-inflammatory factors， Scutellariae Radix group and Coptidis Rhizoma group were lower than Scutellariae Radix-Coptidis Rhizoma group （P<0.05）. Compared with the model group， the "Scutellariae Radix-Coptidis Rhizoma+CLI-095" group and "Scutellariae Radix-Coptidis Rhizoma+PDTC" group had lowered mRNA expressions of TLR4， MyD88， NF-κB p50 and NF-κB p65 （P<0.05， P<0.01）， and the transfer of NF-κB p65 into nucleus was obviously inhibited. ConclusionThe anti-neuroinflammation effect of Scutellariae Radix-Coptidis Rhizoma was significantly better than Scutellariae Radix or Coptidis Rhizom alone， and the anti-neuroinflammation advantage was closely related to the inhibition of activation of TLR4/MyD88/NF-κB signaling pathway in microglial cells. It was confirmed that TLR4， MyD88 and NF-κB were potential targets for Scutellariae Radix-Coptidis Rhizoma to exert the compatibility advantage.