The syndrome differentiation of TCM is the combination of logical thinking and non-logical thinking. There are many factors that can influence the syndrome differentiation, and its core is the thinking model of syndrome differentiation. So many TCM doctors payed attention to it in the past dynasties, and a famous doctor must have good thinking of syndrome differentiation. The writer discussed some common used thinking model of syndromes differentiation on basis of medical records of different dynasties as well as visiting some famous doctors.

Objective To study the clinical value of laparoscopic operation in the treatment of interstitial tubal pregnancy. Methods Clinical data of 21 cases of interstitial tubal pregnancy treated by laparoscopic operation were retrospectively studied. Results Operations in all the 21 cases were conducted successfully,without conversions to open surgery and intra- or post- operative complications.The operation time was 25 ～ 90 min (mean,40 min),and the postoperative hospital stay was 3 ～ 6 d (mean,4.5 d). Conclusions Laparoscopic operation for the treatment of interstitial tubal pregnancy is feasible.

Objective To investigate if isoflurane pretreatment can protect brain from bilateral hemispheric ischemia-reperfusion injury. Methods Seventy-eight male Wistar rats weighing 250-300 g were randomly divided into 4 groups : (A) sham operation group ( n = 15 ); (B) ischemia-reperfusion group (I/R, n = 21); (C) ischemia-preconditioning group (IP, n = 21) and (D) isoflurane pretreatment group (ISO, n = 21) Group B, C and D were further divided into 3 subgroups according to the duration of reperfusion 6 h, 24 h, 72 h. Global cerebral ischemia was produced by 4-artery occlusion technique. In sham operation group (A) bilateral vertebral and common carotid arteries were exposed but not occluded. In ischemia-reperfusion group (I/R) bilateral vertebral arteries were occluded by cauterization and bilateral common carotid arteries were exposed and clamped for 20 min, then undamped for reperfusion of different duration (6 h, 24 h and 72 h) . In ischemia-preconditioning group (C) ischemia-reperfusion was preceded by 3 min global ischemia. In isoflurane-pretreatment group (D) the animals inhaled 1,5% isoflurane for 2 h before I/R. The animals were sacrificed right after reperfusion and brain was removed immediately for microscopic examination of hippocampal CA1. The number of living neurons (HE staining) and apoptotic neurons (TUNEL) was counted. Results (1) In group B (I/R) the number of living neurons in CA1 was decreasing with duration of reperfusion from 90.2 ? 2.4 (after 6 h reperfusion) to 45.8 ??4.9 (72 h of reperfusion) ( P

Objective To evaluate the effect of dexmedetomidine on janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway in mice with endotoxin-induced acute lung injury (ALI).Methods Twenty-four male C57BL/6 mice,weighing 20-25 g,were randomly divided into 3 groups (n=8 each) using a random number table:control group (group C),endotoxin-induced ALI group (group ALI),and dexmedetomidine group (group Dex).ALI was induced with lipopolysaccharide (LPS) 5 mg/kg injected intraperitoneally.Dexmedetomidine 40 μg/kg was injected intraperitoneally at 1 h after LPS injection in group Dex,while the equal volume of normal saline was given in C and ALI groups.At 6 h after LPS injection,blood samples were collected from the carotid artery to detect arterial oxygen partial pressure (PaO2).The mice were then sacrificed,and broncho-alveolar lavage fluid (BALF) was collected for determination of the concentrations of total protein,interleukin-1β (IL-1β),IL-6 and tumor necrosis factor-or (TNF-α).The lung tissues were removed for determination of wet to dry lung weight ratio (W/D ratio),and expression of phosphorylated JAK2 (p-JAK2),phosphorylated STAT3 (p-STAT3),IL-1β mRNA,IL-6 mRNA and TNF-α mRNA,and for examination of the pathological changes which were scored.Results Compared with group C,the PaO2 was significantly decreased,and W/D ratio,lung injury score,concentrations of total protein,IL-1β,IL-6 and TNF-α in BALF,and expression of IL-1β,IL-6 and TNF-α mRNA,p-JAK2 and p-STAT3 were increased in ALI and Dex groups (P＜0.05).Compared with group ALI,the PaO2 was significantly increased,and W/D ratio,lung injury score,concentrations of total protein,IL-1β,IL-6 and TNF-α in BALF,and expression of IL-1β,IL-6 and TNF-α mRNA,p-JAK2 and p-STAT3 were decreased in group Dex (P＜0.05).Conclusion The mechanism by which dexmedetomidine attenuates LPS-induced ALI is probably related to inhibition of activation of JAK2/STAT3 signaling pathway in mice.

Objective To evaluate the effect of goal-directed fluid therapy (GDFT) on postoperative cognitive function in the patients undergoing intracranial tumor resection.Methods One hundred patients of both sexes,aged 45-64 yr,weighing 50-70 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective cerebral glioma or meningioma resection,were randomly divided into 2 groups (n=50 each) using a random number table:GDFT group (group G) and conventional fluid therapy group (group C).The mean arterial pressure was maintained at 65-110 mmHg,urine volume ＞0.5 ml · kg-1 · h-1,and central venous pressure at 8-12 cmH2O in group C.In group G,GDFT was performed using FloTrac/Vigileo system,and the cardiac index was maintained at 2.5-4.0 L · min-1 · n 2,stroke volume variation≤ 13％,mean arterial pressure at 65-110 mmHg,and stroke volume index at 35-47 ml/m2.The requirement for crystalloid and colloid,urine volume,blood loss,and requirement for vasoactive agents were recorded during operation.Before induction of anesthesia (baseline),when the dura of brain was opened,at the end of tumor removal,at the end of operation,and at 24 h after operation (T0-4),venous blood samples were taken to determine the concentrations of serum neuron-specific enolase (NSE) and S100β protein by enzyme-linked immunosorbent assay.The patient's cognitive function was assessed using Mini-Mental State Examination at T0 and 7 days after operation (T5).Results Compared with the baseline value at T0,the serum NSE and S100β protein concentrations were significantly increased at T24 in the two groups (P＜0.05).Compared with group C,the requirement for colloid,total volume of fluid infused and urine volume during operation were significantly increased,the serum NSE and S100β protein concentrations were significantly decreased at T3,4 (P＜0.05),and no significant change was found in Mini-Mental State Examination score at T0 and T5 in group G (P＞0.05).Conclusion GDFT based on FloTrac/Vililgeo system can reduce the damage to brains after operation,but it has no significant effect on postoperative cognitive function in the patients undergoing intracranial tumor resection.

Objective To evaluate the effects of mechanical stretch preconditioning on pathological stretch-induced activation of nuclear factor kappa B (NF-κB) and signal transducer and activator of transcription 3 (STAT3) signaling pathways in human type Ⅱ alveolar epithelial cells.Methods Human type Ⅱ alveolar epithelial cell line A549 cells cultured in vitro were randomly divided into 3 groups (n =24 each) using a random number table: control group (group Ⅰ), pathological stretch group (group Ⅱ), and mechanical stretch preconditioning group (group Ⅲ).In group Ⅰ , A549 cells were cultured routinely without receiving pathological stretch.In group Ⅱ , A549 cells were exposed to 20％ cyclic stretch at 0.3 Hz for 6 h.In group Ⅲ , A549 cells were exposed to 5％ cyclic stretch at 0.3 Hz for 60 min, and then exposed to 20％ cyclic stretch at 0.3 Hz for 6 h.After the end of the treatment, the cells were collected for determination of the cell viability (by methyl thiazolyl tetrazolium assay) and lactate dehydrogeuase (LDH)release (by colorimetric method).The concentrations of tumor necrosis factor-alpha (TNF-α),interleukin-8 (IL-8) and high mobility group box 1 (HMGB1) in the culture medium were detected using enzyme linked immunosorbent assay.The expression of total NF-κB, phosphorylated NF-κB, total STAT3 and phosphorylated STAT3 was detected using Western blot.The ratios of phosphorylated NF-κB to total NF-κB and phosphorylated STAT3 to total STAT3 were calculated to reflect the activation.Results Compared with group Ⅰ , the cell viability was significantly decreased, the amount of LDH released was increased, and the concentrations of TNF-α, IL-8 and HMGB1, and activation of NF-κB and STAT3 were increased in Ⅱ and Ⅲ groups.Compared with group Ⅱ , the cell viability was significantly increased, the amount of LDH released was decreased, and the concentrations of TNF-α, IL-8 and HMGB1, and activation of NF-κB and STAT3 were decreased in group Ⅲ.Conclusion The mechanism by which mechanical stretch preconditioning attenuates pathological stretch-induced damage to human type Ⅱ alveolar epithelial cells is related to inhibited activation of NF-κB and STAT3 signaling pathways.

Objective To investigate surgical outcomes of treatment of pilon fractures of Ruedi -Allgower types Ⅱ and Ⅲ by raft screws fixation combined with bone grafting.Methods 21 patients with pilon fractures of Ruedi -Allgower types II and Ⅲ received surgery were selected.They were 15 men and 6 women,23 to 68 years of age(average 38.2 years).16 cases were closed and 5 cases open.12 cases were type II and 9 cases type III.Intervals between injury and operation ranged from 7 to 14 days,with 8.5 days on average.All of them were treated with raft screws fixation by plate type L combined with bone grafting.Results All cases were followed up for an average of 12 months(range from 8 to 30 months).Fractures healed from 16 to 24 weeks,with 18.2 weeks on average.According to the Burwell -Charnley radiological criteria,anatomical reduction was achieved in 17 cases,and fair reduction in 4.According to the Mazur clinical criteria,ankle functions were rated as excellent in 8 cases,good in 10 cases,fair in 2 cases and poor in 1 case.The rate of excellent and good was 85.7%.Conclusion Raft screws fixation combined with bone grafting are effective for the pilon fractures of Ruedi -Allgower types II and Ⅲ,preventing articular surface collapse and leading to anatomic reduction,and has stable fixation and early functional rehabilitation.

ObjectiveToexploretheeffectof ceremideonprocess of peritoneal mesothelial cells(PMCs) apoptosis induced by peritoneal dialysis solution(PDS).Methods PMCs were cultured with normal DMEM,1.5％ PDS and 4.25％ PDS.4.25％ mannitol was used as high osmotic pressure control.Ceremide were detected by LC-MS-MS.Flow cytometry was used in apoptosis analysis.Bax,p53 and bcl-2 protein expressions were detected by Western blotting.Results (1) PDS caused the increase of intracellular ceremide in PMCs,and normal and high osmotic pressure controls had no such effect.As the acidic sphigomyelinase inhibitor,desipramine significantly inhibited the production of ceramide induced by 4.25％ PDS [(56.08±12.24) μg/L vs (91.25:t:15.89) μg/L,P＜0.01]. (2) Compared with 1.5％ PDS,4.25％ PDS stimulated PMCs apoptosis (26.65％±6.21％ vs 4.04％±1.86％,P＜0.01),up-regulated bax and p53 proteins expression (P＜0.01),and down-regulated bcl-2 protein exprssion(P＜0.05).Desipramine obviously inhibited the apoptosis induced by 4.25％ PDS,decreased bax and p53 proteins expression,increased bcl-2 protein expression(P＜0.05).Exogenous C2-ceremide reversed the effect of desipramine(P＜0.05).Conclusion The increase of intracellular ceremide may play an important role in the PMCs apoptosis induced by high glucose PDS.

Objective To observe the Klotho expression in kidneys and renal tubular epithelial cells apoptosis in spontaneously hypertensive rats (SHRs) and the effects of cordyceps sinensis (CS), in order to study the mechanism of protective effects of CS on renal tubular cells apoptosis in hypertensive renal damage. Methods Twenty 22-week-old male SHRs were control group. After 8 weeks, the levels of 24 hours urinary protein (Upre), urinary N-acetyl-β-D-glucosaminidase (NAG), serum creatinine (Scr), blood urea nitrogen (BUN) and renal pathological changes were detected; the mRNA expression of Klotho, 053 and 021 was detected by RT-PCR; the protein expression of Klotho, 053, 021 and cleaved-caspase-3 was tested by Western blotting. TUNEL assay was applied to evaluate the renal tubular cell apoptosis. Results As compared to SHR group, the levels of 24 h urinary protein content [(52.16±29.3) mg, (49.97±32.5) mg, (54.67±30.09) mg vs (96.52±36.94) mg], urinary NAG [(44.13±9.11), (42.75±8.33), (41.96±7.88) U/L vs (54.07±6.57) U/L], Sct [(45.25±9.55), (43.76±8.65), (45.18±7.28) μmol/L vs (53.84±10.21) μmol/L]and BUN [(8.25±1.03), (8.40±1.58), (8.32±0.98) mmol/L vs (8.91±1.24) mmol/L]were decreased (all P<0.05), renal pathological changes were relieved, the levels of Klotho expression were up-regulated and the levels of p53 and p21 expression and cleaved-caspase-3 protein expression were down-regulated (all P<0.01), tubular cell apoptosis was decreased [7.56%±0.52%, 7.93%±0.37%, 7.37%±0.36% vs 13.32%±0.64%, P<0.01] in CS, Los and CS+Los group. Conclusions Klotho, p53 and p21 play important roles in renal tubular cells apoptosis in hypertensive renal damage. CS can up-regulate Klotho expression, down-regulate p53 and p21 expression and decrease the cleaved-caspase-3 expression and tubular cell apoptosis to ameliorate the hypertensive renal damage.

Objective To evaluate the effectiveness of treating glioma in combination of two kinds of drugs by comparing the size of tumors and the survival time of different groups in rat glioma after targeted blood‐brain barrier (BBB) disruption by focused ultrasound under MRI‐guide. Methods The stereotaxis instruments and the 10 μl gas‐tight syringes were used to inject gliosarcoma cells into the targeted area of the brain in 40 male Sprague‐Dawley rats. The glioma‐bearing rats models were established. Rats were divided into 4 groups to receive different treatment :(1) no treatment (control, n = 8), (2) IV Avastin (Avastin only, n =10), (3) IV liposomal doxorubicin (DOX only, n =10), (4) IV Avastin and liposomal doxorubicin (Avastin+DOX, n =10). The SonoVue microbubbles and DOX or Avastin were injected into the tail vein respectively on the 12th day after implantation. The tumor size was measured by MRI on immediacy, once a week after targeted BBB disruption by focused ultrasound, and the life span in rat glioma was recorded. Results The average survival time of different groups in rat glioma was as follows :no treatment(17 ± 4)d, Avastin(20 ± 4)d, DOX(25 ± 5)d, DOX+ Avastin(40 ± 5)d. The tumor size after post‐treatment of different groups in rat glioma was as follows :no treatment(5 7.0 ± 4 3.0)mm, Avastin(4 3.0 ± 2 5.0)mm, DOX(4 1.2 ± 3 1.0)mm, DOX + Avastin(2. 20 ± 1. 30)mm. There was significant increased in average survival time and decreased in tumor size after a combination treatment DOX+ Avastin compared with other groups( P < 0 0.1). Conclusions The microbubble blasting by MRI‐guided focused ultrasound enhances the local tissue permeability and promotes the drug delivery of chemotherapy and anti‐angiogenesis locally in glioma‐bearing rats. Especially, the combination of two kinds of drugs has a synergism efficacy that may reduce tumor growth and increase survival time significantly after BBB disruption.