The estrogen receptor (ER) coregulators regulate the transcriptional activities of ER,and then affect the transcription and translation of target genes mediated by ER.ER coregulators not only plays an important role in the initiation,progression and metastasis of breast cancer,but also involves in the response to endocrine therapy of breast cancer via the genomic and nongenomic function.

Objective　To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. Methods　Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm×5.0 cm to 4.5 cm ×11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm ×8 cm to 12 cm×25 cm. Results　All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. Conclusion　The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.

ObjectiveTo explore the influence of life events on the emotional state ot heart transplantation patients.Methods All the heart transplantation outpatients were interviewed by a certain psychiatrist in Zhongshan Hospital during Oct.2010 to Oct.2011.The demographic data,life events and the self-reported influenced degree were recorded by the same psychiatrist.A grounded theory-based approach with thematic content analysis of the field notes was used.ResultsEighty-eight patients were enrolled,including 69 males,and19 females.The average age of the patients was 46.5 ±14.3 years old.The average duration after operation was 39.3 ± 39.6 months.The life events were classified into 4 groups,which were medical financial problems,physical condition,family support and future life.The most frequently reported event was physical condition (50.2％ ) and the influenced degree was the highest (9.2 ±1.2),while most patients (96.6％) complained high medical and relevant cost and the influenced degree was (6.5 ± 2.1). Family support was reported by13.6％ patients and its influenced degree was (7.6 ±1.2).The age of the reporter of future life (6.8％) was under 33 years.ConclusionDifferent events have different influence to patients.Improving the social support of patients is helpful to improve quality of life.

Objective To observe the effects of different doses of dexmedetomidine combined with ropiva-caine for ultrasound-guided fascia iliaca compartment block on postoperative analgesia and rehabilitation in patients undergoing total hip replacement surgery. Methods 80 patients with ASAⅠ~Ⅱundergoing total hip arthroplasty were ramdonly divided into 4 groups. Records of patients with ultrasound guided fascia iliaca compartment block onset time,block fading time,VAS at 4 h,8 h,12 h,24 h,48 h;duration of operation,intraoperative remifent-anil and propofol requirement;24 h and 48h of sufentanil use;after the operation were recorded for the first time , ambulation time,hospitalization time and observe whether bradycardia,intraoperative awareness and other adverse reactions. Results Compared with group A and B,the onset time of C were shorter(P<0.05);the VAS was less (P<0.05);the remifentanil equirement was significantly was reduced(P<0.05);the amount of sufentanil after operation 24 h and 48 h was reduced(P<0.05);the first time out of bed time and total hospitalization time was shorter(P < 0.05);patient satisfaction increased(P < 0.05);The extubation time was significantly longer and the occurrences of tachycardia were significantly increased in group D compared to other groups respectively. Conclusion 1.0μg/kg dexmedetomidine combined with 0.3%ropivacaine ultrasound-guided fascia iliaca compart-ment block can provide better postoperative analgesic and recover rapidly with fewer side effects in total hip replace-ment surgery.

AIM: To determine the dissolution of Longdan Xiegan Pills(Radix et Rhizoma Gentianae,Radix Scutellariae,Fructus Gardeniae,etc.) on the basis of markers such as gentiopicroside,baicalin and geniposide. METHODS: According to Appendix ⅩCⅢ of Chinese Pharmacopoeia 2005 edition VolⅡ,dissolution medium was 100 mL 0.5% SDS aqueous solution and rotating speed was 100 r/min.The dissolution solution of pill was taken and analyzed by HPLC method.A column of Kromasil C_(18)(4.6 mm?250 mm,5 ?m) was used.The mobile phase composed of A acetonitrile,B 1% glacial acetic acid aqueous solution,gradient eluation.The flow rate was 1.0 mL/min with the detection wavelength at 254 nm. RESULTS: The average dissolution of three batches of gentiopicroside,baicalin and geniposide exceeded the marker amount by factor of 0.75 time in 4 h. CONCLUSION: A reliable and qualitative method is established with good reproducibility for determination of dissolution of Longdan Xiegan Pills.

Objective The aim of this study was to explore the minimally invasive treatment for palpable undescended testes in the inguinal area.Methods Between August 2007 and March 2008,60 cases(74 testicular units)with palpable undescended testes in the inguinal area were treated by scrotal incision orchiopexy or/and laparoscopic orchiopexy depending on the location of inguinal testes.Results Among the 60 patients,26 cases who had the testes located between the external inguinal ring and the upper scrotum,received scrotal incision orchiopexy,of which the testes were fixed at the bottom of the scrotum in 23 cases,and at the upper scrotum in 1 case;the other 2(both had the undescended testis at the right side,between the external inguinal ring and the upper scrotum)were converted to laparoscopic orchiopexy because of unsatisfying surgical outcomes.The other 34 cases received laparoscopic orchiopexy,of which the testes were located in the groin in 16(41.1%)cases,close to the external inguinal ring in 18(52.9%),and complicated with indirect inguinal hernia in 8(23.5%,ligation of the hernia sac was performed at the level of internal inguinal ring);the testes were fixed at the bottom scrotum in the cases.The 60 patients were followed up for 3-6 months(mean,4.3 months)by B-ultrasonography,none of them showed atrophy or retraction of the testes,or indirect inguinal hernia.ConclusionsScrotal incision orchiopexy is feasible for palpable inguinal testes if the testis can be pulled upon to the upper scrotum,if not or the testis cannot be fixed on the bottom scrotum,laparoscopic orchiopexy should be used.Both of the procedures are effective.

Objective To study the clinical practical use of the model for end-stage liver disease(MELD) and assess its validity in predicting the prognosis of the.chronic severe hepatitis patients.Methods The clinical data of 391 patients with chronic severe hepatitis among 2003～2005 in our hospital were analyzed,and they were graded with MELD formula.These patients were divided into plasma exchange group and none plasma exchange group according to plasma exchange treatment or not.The death rate was observed within three months.The validity of the model in predicting the prognosis of the patients with severe hepatitis was determined by the concordance(c)-statistic.Results 236 patients died within three-months and the mortality was 60.6%.The mortality of patients in PE group whose MELD score were less than 30 and 30～40 was 25% and 75% respectively,but in non-PE group they were 42.0%,90.7% respectively,there were significant difference between PE group and non-PE group(P0.05).The optimal cut-off values of MELD to predict the prognosis of patients were 30 in PE group whose sensitivity and specificity were 66.7% and 86.4%,and its c-statistic was 0.823(95% CI 0.734～0.912);and in non-PE group they were 27,76.4%,79.1% and 0.832(95% CI 0.787～0.877) respectively.Conclusions The mortality of the patient with chronic severe hepatitis increases with the increase in the MELD score.The MELD can accurately predict the short-term prognosis of patients with chronic severe hepatitis.

Objective To OxplorO thO rOlationship bOtwOOn diffOrOnt vOntilation modO and hypocapnia in prOtOrm infants.Methods From April 2014 to OctobOr 2017,a total of 302 prOtOrm infants with rOspiratory distrOss syndromO in Suining COntral Hospital who rOcOivOd diffOrOnt assistOd vOntilation wOrO sOlOctOd in this rOsOarch. According diffOrOnt vOntilation modO, thOy wOrO dividOd into convOntional mOchanical vOntilation(CMV) group( n=66),thO mOchanical vOntilation modO was CMV, continuous positivO airway prOssurO(CPAP) group(n=149),thO mOchanical vOntilation modO was CPAP, high frOquOncy vOntilation(HFOV) group(n=87),thO mOchanical vOntila-tion modO was HFOV. ThO morbidity of hypocapnia in diffOrOnt groups and prOvOntion mOthods wOrO analyzOd. Results Among 302 childrOn,52casOs had hypocarbonOmia,thO total morbidity of hypocapnia was 17.2%. ThO morbidity of hypocapnia in thO HFOV group was 37.9% (33/87),which in thO CMV group was 21.2% (14/66), which in thO CPAP group was 3.4% (5/149),thO diffOrOncO among thO thrOO groups was statistically significant(χ2 =47.013,P=0.000).Conclusion ThO incidOncO of invasivO vOntilation should bO carOfully considOrOd in prOtOrm infants, OspOcially high frOquOncy vOntilation. To prOvOnt and trOatmOnt of hypocapnia, timOly adjustmOnt of vOntilator paramOtOrs according to blood gas during diffOrOnt vOntilation modO should bO donO.

Objective To investigate the prevalence of systemic fungal infection in patients at auto-psy and its association with clinical data.Methods The materials from unselected adult patients were exa-mined at necropsy in our hospital from1971to2000,and the fungal species were identified by their mor-phologies in pathology.The clinical and pathological data were compared.Results The rate of fungal infec-tion was7.8%(31/396)among396cases.Seventeen(54.8%)of the31cases were infected with as-pergillus.The frequencies of organs involved with fungal infection were83.87%in lungs,48.39%in kid-neys,35.48%in brain and29.03%in heart,respectively.The fungal infection attributed directly to death in21cases.Conclusion Systemic fungal infection is one of the most common fatal causes among the critically ill patients,and aspergillosis becomes a major pathogenic fungus for patients with systemic fungal infection at autopsy.

OBJECTIVE:To try to establish a combined serum-pharmacology and electrophysiology method for the study of mechanism of chuanxiong extract in dilatating coronary artery.METHODS:Chuanxiong extract was intragastrically given to rats and mice,then the serum contents of tetramethylpyrazine(TMP)were determined by HPLC,which provided data for electrophysiological study.The action of chuanxiong extract on Ca 2+ -activated K channel(Kca)of smooth muscle of coronary artery in pigs was studied by patch clamp technique.RESULTS:The calibration curve of TMP was linear in the range of0.216～54?g/ml(r=0.9999).The recovery was100.7%～102.4%.The serum concentrations of TMP in rats and mice were(3.56?3.01)and(8.19?6.57)?g/ml respectively.The chuanxiong extract could not markedly activate the Kca of smooth muscle of coronary artery in patch clamp study.CONCLUSION:The established method for TMP determination is feasible and relieable.In order to improve the combined electrophysiology and serum pharmacology technique,high quality medical materials should be adopted and the bioavailability improved.