DQA1*0501.TSHR peptides of 183～198、195～210、248～263、301～320、343～362 and 357～376 could bind with high affinity to both HLA-DR3 and HLA-DQA1*0501,all of their IC50 values less than(1 ?mol/L),but they could bind to neither HLA-DR7 nor HLA-DQA1*0201 with high affinity.Conclusion Epitopes of TSHR 183～198,195～210,248～263,301～320,343～362 and 357～376 on the TSHR extracellular domain might be the auto-antigens to cause GD.

Despite the availability of six classes of antihypertensive agents, control of blood pressure and improving patients' quality of life remain far from ideal. There is a wide variability in terms of the hypotensive effect and side effect profile for the same antihypertensive agent used in different patients. How to select the right agent to provide the most beneficial results in terms of efficacy and improvement of quality of life as well as to decrease clinical symptoms and minimize adverse reactions is an important therapeutic challenge. It has been suggested that clinical usage of pattern (Zheng) diagnosis of traditional Chinese medicine may improve the accuracy in selecting the right antihypertensive agents with improved efficacy and deceased adverse effects. Limited research in this area suggested the calcium channel blocker may work better in treating phlegmatic damp excess pattern and blood stasis pattern while beta-blockers may be more beneficial in the liver yang rising pattern. On the other hand, angiotensin converting enzyme inhibitors may be more suitable in a yin deficiency and yang hyperactivity pattern as well as combined liver and kidney yin deficiency pattern. More research studies using this innovative approach in improving the selection of antihypertensive agents including mechanistic studies are urgently needed.

Adult ; Chlorine ; poisoning ; Humans ; Male ; Middle Aged ; Phosgene ; poisoning ; Respiratory Distress Syndrome, Adult ; chemically induced

4-Hydroxycoumarins ; poisoning ; Acute Disease ; Adult ; Humans ; Male ; Poisoning ; diagnosis ; Prothrombin Time

OBJECTIVE:To investigate the satisfaction degree of outpatients on policy of separation of clinical pharmacy from 4 third grade hospitals in Shanghai,and provide reference for promoting medical reform policy. METHODS:Parts of outpatients in the 4 new suburb third grade hospitals were investigated by the questionnaire and interview in Shanghai city,and the data was sta-tistically analyzed by Excel software and SPSS 19.0 software. RESULTS:Totally 400 questionnaires were sent out and 368 were valid with effective recovery of 94.3%. The awareness rate of medical separation policy was 81.3% in the outpatients;55.5% of outpatients thought that medicine cost savings effect was not obvious;the overall satisfaction of patients was 91.6%,and the high-est of satisfaction was the service attitude and the lowest was medical expenses. CONCLUSIONS:Policy of separation of clinical pharmacy has reduced the medical expenses,guided the triage treatment of patients partly and improved the satisfaction of patients. It is suggested to shorten the waiting time by optimizing examination process,strengthen price regulation in drug,standardize pro-duction and distribution process,improve use rate of essential medicines and promote clinical rational drug use for further improve-ment of satisfaction.

Objective To investigate the expression and biological function of microRNA-34a (miR-34a) in bladder cancer.Methods Forty-two cases of bladder cancer specimen,including 17 noninvasive carcinoma and 25 muscle invasive carcinoma classified by UICC 2002 TNM,or 18 low-grade and 24 high-grade classified by WHO 1973.Meanwhile,mucosa adjacent to the carcinoma was selected as normal control.The gene expression of miR-34a was determined using real-time quantitative polymerase chain reaction in 42 cases of bladder carcinoma samples.Mature mimics of miR-34a were chemically synthesized and transiently transfected-intoT24 bladder cancer cells.The effects of miR-34a on apoptosis and proliferation in T24 cells were evaluatedby flow cytometry and MTS respectively.Results 61.9％ of carcinoma samples showed low expression of miR-34a,which was correlated with the malignancy and tumor size of bladder carcinoma.26.5％ (11 cases) was negative and 11.6％ (5 cases) showed high expression.Furthermore,upregulation of miR-34a in T24 cells contributed to cell growth and apoptosis.The apoptosis rate of T24 cells was (9.11 ± 0.41)％,which had significant difference compared with NC mimics and blank control group respectively (P ＜ 0.01).Conclusion The relative low expression of miRNA-34a may be involved in the tumorigenesis and development of bladder carcinoma.

Objective To observe the clinical effects of eyehd reconstruction by regional flap combined with xenogeneic acellular dermal matrix transplantation for eyelid defect after malignant tumor excision.Methods Thirty-five cases (35 eyes) in our hospital were selected as the objects.Among them,basal cell carcinoma was 21 cases,meibomian gland carcinoma was 13 cases,squamous cell carcinoma was 1 cases;12 cases of upper eyelid and 23 case of lower eyelid were involved.All patients were subjected to intraoperative frozen,and the incision margin was determined according to the frozen results.After resection of the tumor,the eyelid had full-thickness defects in different degrees.The xenogenic acellular dermal matrix was used to replace the conjunctival tarsal tissue,and the adjacent flap or transposition flap was used to repair the eyelid defect according to the size of skin defect.The healing of flap,oral repair film,eyelid closure and adhesion were observed.Results After half a year follow-up,the acellular dermal matrix were completely dissolved by crawling the conjunctival epithelium covering,the flap healed with no flap necrosis.28 patients recovered well after operation without hypophasis and entropion,ectropion.4 patients had mild hypophasis,and there was no case of exposure keratitis.3 patients were with mild symblepharon.Conclusion The acellular dermal matrix can replace tarsal conjunctival tissue,which combined with regional flap has good clinical curative effect for eyelid defect after malignant tumor excision.This treatment can reduce the pain of patients who take oral mucosa and avoid the reoperation of eyelid reconstruction.

OBJECTIVE:To determine serum concentrations of western medicines in patients treated with "traditional Chinese antiepileptic medicine" alone and to evaluate the curative effects.METHODS:A total of 60 epileptic patients who visited our hospital between Feb.1997 and June 2006 were subjected to plasma drug level monitoring and during which the patients were treated with "traditional Chinese antiepileptic drugs" alone.Plasma concentrations of 4 kinds of western medicin-es were determined by FPIA.RESULTS:Of the 60 cases,valproic acid,carbamazepine,phenytoin and phenobarbitone were detected in 18,40,41,and 47 cases/times,respectively.On average,more than two kinds of western medicines were detected in every patient,and the blood concentrations were mostly beyond effective plasma drug concentration.The total curative effects were unsatisfactory.CONCLUSION:The fact that western medicine ingredients detected in these traditional Chinese antiepileptic medicines is inconformity with medication principle of epilepsy.Traditional Chinese antiepileptic medicines should be used with caution in the clinic in the treatment of epileptic patients.

Objective:To explore the way to separate and culture eutopic and ectopic endometrial glandular cells and their stromal cells,providing an in vitro cell model of endometriosis for study of its mechanism. Methods:Digestion,filtration and sedimentation were used to isolate and culture the eutopic and ectopic endometrial glandular cells and their stromal cells. The estrogen level was imatated to study the way of promoting cell growth. Morphological characters of eutopic and ectopic endometrial cells were examined using optical microscope. Results:The success rate of separation and culture of normal control endometrial glandular cells and its stromal cells was 91.7%(11/12);of eutopic endometrial glandular cells and its stromal cells of endometriosis was 93.8%(15/16);of etopic endometrial glandular cells and its stromal cells of endometriosis was 75.0%(12/16) . Conclusion:The cultured eutopic and ectopic endometrial cells is more like human body feature than the endometriosis model of animals. So the isolation and culture of eutopic and ectopic endometrial glandular cells and their stromal cells may serve as an in vitro experimental model.

Objective:To explore the effect of different tidal volumes (VT) on the hemodynamics of right heart in acute respiratory distress syndrome (ARDS) rats induced by oleic acid (OA).Methods:Sixty adult male Sprague-Dawley (SD) rats were divided into control group ( n = 20), ARDS model group ( n = 20), low VT (LVT) group ( n = 10) and high VT (HVT) group ( n = 10) by random number table. ARDS model was reproduced by injecting OA 0.15 mL/kg through a jugular vein. The control group was given the same amount of normal saline. The success of modeling was judged by the oxygenation index (PaO 2/FiO 2) 2 hours after modeling, at the same time, the lung tissues were collected, the wet/dry weight (W/D) ratio was determined, and the lung histopathological changes were measured by lung injury score. The rats in the LVT group and HVT group were given mechanical ventilation with VT of 6 mL/kg or 20 mL/kg for 4 hours, respectively at 2 hours after modeling. The rats in the control group and the ARDS model group maintained spontaneous breathing. After mechanical ventilation for 4 hours, the heart rate (HR), right ventricular systolic pressure (RVSP), the maximum rate of rising of right ventricular pressure (dp/dt max), and the blood pressure (BP) were measured. Meanwhile, arterial blood samples were collected for blood gas analysis, including pH value, arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2) and PaO 2/FiO 2. Results:The rats in the ARDS model group showed symptoms of respiratory distress 1 hour after modeling, and the lung tissue samples showed obvious patchy bleeding 2 hours after modeling, while the control group showed no such changes. The PaO 2/FiO 2 in the ARDS model group was significantly lower than that in the control group [mmHg (1 mmHg = 0.133 kPa): 294.3±5.9 vs. 459.0±4.4, P < 0.01], and the lung W/D ratio and lung injury score were significantly higher (lung W/D ratio: 8.24±0.25 vs. 4.48±0.13, lung injury score: 0.60±0.03 vs. 0.12±0.02, both P < 0.01). It indicated that ARDS model was successfully reproduced. The arterial blood gas analysis and hemodynamic parameters of the ARDS model group were significantly worse than those of the control group. After 4-hour mechanical ventilation, the blood gas parameters of the LVT group were better than those of the ARDS model group and the HVT group [pH value: 7.36±0.02 vs. 7.24±0.02, 7.13±0.01; PaO 2 (mmHg): 92.4±2.1 vs. 61.8±2.3, 76.6±2.2; PaCO 2 (mmHg): 49.6±1.7 vs. 61.8±1.8, 33.6±1.3; PaO 2/FiO 2 (mmHg): 440.0±10.2 vs. 274.3±21.4, 364.7±10.5; all P < 0.05]. HR, BP and dp/dt max in the LVT group were significantly higher than those in the ARDS model group and the HVT group [HR (bpm): 346.9±5.4 vs. 302.3±10.1, 265.5±12.2; BP (mmHg): 125.4±2.2 vs. 110.0±2.5, 89.2±2.8; dp/dt max (mmHg/s): 1 393.3±30.3 vs. 1 236.4±20.5, 896.1±19.5; all P < 0.05], and RVSP was significantly lower than that in the ARDS model group and the HVT group (mmHg: 31.3±0.4 vs. 34.0±1.0, 38.8±0.9, both P < 0.05). Conclusion:Mechanical ventilation with low VT can improve the hemodynamic parameters of the right ventricle and protect the function of the right heart in ARDS rats.