Objective To study antitumor and hemolytic activities of nobiliside B from the sea cucumber Holothuria nobilis Selenka and its acetylic ramification.Methods Triterpene glycoside nobiliside B was acetylated with pyridine and Ac2O in icy bath,the acetylic products were separated by multi-chromatography to afford acetoxy-nobiliside B(2).The cytotoxic activity of the glycosides against ten human tumor cell lines was evaluated with the sulforhodamione B(SRB) protein assay.Results On the basis of chemical method,spectroscopic analysis and comparison with the data of nobiliside B,the structure of compound 2 was elucidated as: 3-O-[6″-acetoxy-?-D-glucopyranosyl(1→2)-4′-O-sulfate-?-D-xylopyranosyl]-holosta-9-ene-22,25-epoxy-3?,17?-diol-sodium salt.The bioassay results showed that the hemolytic activity of compound 2 was significantly decreased,while the antitumor activity was kept.Conclusion One novel acetoxy compound with high antitumor activitiy and less side effect was obtained by structure modification of nobiliside B,and should be study as a new potential antitumor drug.

PHA,PMA or OKT3 McAb alone can not induce the proliferative responses of purified resting T cells,which enables us to comparise the effects of exogenous IL—2,IL—4 and IL—6 on the activation and proliferation of T cell.PHA can induce purifeid resting T cells responding to exgenous IL—2,IL—4 or Il—6 and anti—Tac(p55)McAb only blocked the proliferative response of PHA—stimulated T cells responding to IL—2.PMA can induce purified resting T cells responding to exogenous IL—2 or IL—4 but not Il—6.OKT3 McAb only induced the purified resting T cells responding to exogenous IL—2.Cyclsporin A,an immunosuppressant(CsA),inhibited the proliferative responses of PHA—stimulated T cells responding to exogenous IL—2,IL—4 or IL—6,but in the kinetic study of inhibitory affect of CsA,the results were completely different.Our data suggest that IL—2,IL—4 and IL—6 activate T cell by different pathway.

Objective To investigate the changes and significance of risk factors (blood lipid ,UA ,visfatin ,HCY and hs CRP) for cardiovascular diseases in patients with subclinical hypothyroidism(SCH) .Methods One hundred patients with SCH were divided into observation group A (5 mIU/L≤TSH<10 mIU/L ,n=60) and observation group B (TSH≥10 mIU/L ,n=40) in accordance with thyroid stimulating hormone (TSH ) level .The control group included one hundred healthy individuals .We measured the factors of cardiovascular diseases such as TSH ,total cholesterol (TC) ,triglyceride (TG) ,high density lipoprotein cholesterol (HDL‐C) ,low density lipoprotein cholesterol (LDL‐C) ,serum uric acid (UA) ,visfatin ,homocysteine (HCY) and high sensitive C‐reactive protein (hs‐CRP) and visfatin level .Results The levels of TG and visfatin of observation groups were signifi‐cantly higher than control group (P<0 .05) .In group B ,levels of TG ,visfatin ,LDL‐C ,UA ,HCY and hs‐CRP were much more sig‐nificantly higher than control group(P<0 .05) ,and TG and visfatin had the most significant increase (P<0 .01) ,and there were no significant different in HDL‐C in group A and B(P>0 .05) .Conclusion In Subclinical hypothyroidism patients ,lipid disorders and hyperuricemia are the risk factors of thyroid nodules and coronary heart disease .HCY ,hs‐CRP and visfatin should be used as the indicators to evaluate the cardiovascular risk .

Objective To observe the clinical efficacy of electroacupuncture plus muscle energy technique (MET) in treating upper crossed syndrome (UCS).Method Forty UCS patients were randomized into a treatment group and a control group, 20 cases in each group. The control group was intervened by electroacupuncture, while the treatment group was treated with MET to relax and regulate the cervical and shoulder muscles in addition to electroacupuncture. The two groups were treated once a day, for 3 weeks in total. The Visual Analogue Scale (VAS), Neck Disability Index (NDI), Hamilton Depression Scale (HAMD) and Pittsburgh Sleep Quality Index (PSQI) were observed before and after the intervention, and the clinical efficacies were compared between the two groups.Result After the treatment, the VAS, NDI, HAMD, and PSQI scores were significantly changed in both groups (P<0.05). The scores of all parameters in the treatment group were significantly different from those in the control group (P<0.05). The total effective rate was 95.0% in the treatment group versus 85.0% in the control group, and the between-group difference was statistically significant (P<0.05).Conclusion Electroacupuncture plus MET can improve the pain, depression, sleep disorder, and the quality of life of UCS patients.

Objective: The aim of this report was to discuss the type, timing, and surgical techniques of permanent pacemaker implantation in a juvenile patient.
Patients: A 17-year-old girl with Down syndrome and congenital heart defects comprised of ventricular septal defects (VSD) and patent ductus arteriosus (PDA) suffered from postoperative complete atrioventricular block (AVB) when she was 7 months old.
Methods and Results: An epicardial pacemaker was implanted just after the occurrence of complete AVB. Due to the pacing threshold of a ventricular lead not being good, the battery showed rapid depletion. Her generator had to be exchanged under general anesthesia every 2–3 years. When she was 10 years old, we implanted a permanent pacemaker transvenously by using cutdown, screw-in and subpectoral pocket techniques. She has shown a satisfactory outcome since then.
Conclusion: Transvenous pacemaker implantation was safe and effective in our young patient without any complications. The timing of surgery and surgical technique are quite important for pacemaker implantation in juvenile patients.

Objective: The aim of the present study was to consider the importance of medical information obtained via the Internet for difficult cases in hospitals, especially in those located in rural areas. We report here a case of congenital arteriovenous fistula (AVF) in the upper extremities.
Patient: A 30-year-old lady was transported to our hospital by ambulance due to massive bleeding in her left hand. She was seen by our current cardiovascular surgery team for the first time, although she had been diagnosed with congenital AVF of the left arm 9 years previously. Because it was asymptomatic, she was followed up by observation. During 5 years of observation, symptoms such as cyanosis, pain, and refractory ulcers gradually developed. When she was 26 years old, she was referred to a university hospital in Akita, but surgery had already been judged to be impossible. When she was 30 years old, traumatic bleeding in her left hand and hemorrhagic shock led her to be taken to our hospital by ambulance. Using the Internet, we found an institution that had treated a large number of cases of AVF. After controlling the bleeding, we referred her to that institution. However, she could not be treated without an above-elbow amputation.
Conclusion: Congenital AVF in the upper extremities is a rare vascular anomaly and has been generally accepted to be an extremely difficult disease to treat. Treatment should be started as early as possible before the presence of any symptoms. When a specialist is not available near the hospital, precise information must be found using the Internet and the patient should be referred without any delay.

Objective: The aim of the present study was to consider the importance of medical information obtained via the Internet for difficult cases in hospitals, especially in those located in rural areas. We report here a case of congenital arteriovenous fistula (AVF) in the upper extremities.
Patient: A 30-year-old lady was transported to our hospital by ambulance due to massive bleeding in her left hand. She was seen by our current cardiovascular surgery team for the first time, although she had been diagnosed with congenital AVF of the left arm 9 years previously. Because it was asymptomatic, she was followed up by observation. During 5 years of observation, symptoms such as cyanosis, pain, and refractory ulcers gradually developed. When she was 26 years old, she was referred to a university hospital in Akita, but surgery had already been judged to be impossible. When she was 30 years old, traumatic bleeding in her left hand and hemorrhagic shock led her to be taken to our hospital by ambulance. Using the Internet, we found an institution that had treated a large number of cases of AVF. After controlling the bleeding, we referred her to that institution. However, she could not be treated without an above-elbow amputation.
Conclusion: Congenital AVF in the upper extremities is a rare vascular anomaly and has been generally accepted to be an extremely difficult disease to treat. Treatment should be started as early as possible before the presence of any symptoms. When a specialist is not available near the hospital, precise information must be found using the Internet and the patient should be referred without any delay.

Objective: The aim of this report was to discuss the type, timing, and surgical techniques of permanent pacemaker implantation in a juvenile patient.
Patients: A 17-year-old girl with Down syndrome and congenital heart defects comprised of ventricular septal defects (VSD) and patent ductus arteriosus (PDA) suffered from postoperative complete atrioventricular block (AVB) when she was 7 months old.
Methods and Results: An epicardial pacemaker was implanted just after the occurrence of complete AVB. Due to the pacing threshold of a ventricular lead not being good, the battery showed rapid depletion. Her generator had to be exchanged under general anesthesia every 2–3 years. When she was 10 years old, we implanted a permanent pacemaker transvenously by using cutdown, screw-in and subpectoral pocket techniques. She has shown a satisfactory outcome since then.
Conclusion: Transvenous pacemaker implantation was safe and effective in our young patient without any complications. The timing of surgery and surgical technique are quite important for pacemaker implantation in juvenile patients.

Objective To study the effect of anti-hepatitis B virus of Lamivudine combined with Saikosaponins in vivo. Methods Chongqing duck hepatitis B model was selected and given to Lamivudine combined with Saikosaponins(combined group) oral treatment 28d, then the ducks were observed 7d after drug withdrawal. The levels of serum HBV DNA, HBsAg and transaminase(ALT, AST) were detected before and after treatment, and compared with that in Lamivudine group and Saikosaponins group as control. Results In combined group,the levels of serum HBV DNA and HbsAg were significantly decreased(P ＜ 0.05), and 7d after drug withdrawal the levels of serum HBV DNA and HBsAg showed no" anti-jump" compared with that at drug treatment 28d(P ＞ 0.05). In Lamivudine group and Saikosaponins group the levels of those increased again 7d after drug withdrawal (P ＜ 0. 05). In each group the levels of serum ALT and AST did not change within the same phase during drug treatment 28d and 7d after drug withdrawal(P ＞ 0. 05). Conclusion Lamivudine combined with Saikosaponins in vivo had the effect of anti-hepatitis Bvirus, and the effect was stable and lasting.

Objective To explore the clinicopathological features,diagnosis and differential diagnosis of colonic muco-submucosal elongated polyp (CMSEP).Methods The clinical manifestations,endoscopic and histological features of three cases of CMSEP were analyzed.The literature was reviewed with regard to the diagnostic criteria and differential diagnosis.Results Three patients were male,and aged 25,45 and 75 years old.Two polyps were at transverse colon and one at rectum.Under colonoscope,all three cases showed the long pedunculated polyps.The surfaces of two polyps were smooth and the colors were similar to colonic mucosa while one polyp appeared mucosal erosion and congestion on the top.Under optical microscope,three cases had similar lesions.The axis of the lesions was expanded submucosa and the surface was the layer of colonic mucosa.The expanded and thick walled blood vessels were seen paralleled to the long axis in the submucosa of the axis of lesions.One polyp with mucosal erosion on the top presented with adenocarcinomal changes.Conclusions CMSEP is a kind of specific polypoid lesion,with characteristic colonoscopic and pathological features.Most are benign changes,however malignant changes occur in a few cases.In histology,CMSEP should be identified with mucosal prolapse syndrome associated inflammatory polyp.