The tumorigenesis of breast cancer is a multistep process with many factors.The microRNAs (miRNA) participates in the development and distance metastasis of tumor by regulating proliferation,apoptosis and migration of tumor cells.The study of the mechanisms that miRNA impacting breast cancer cell proliferation and metastasis may provide new ideas for the diagnosis and treatment of breast cancer.

Objective To explore the efficacy and safety of low-dose ketamine for prevention of shivering during cesarean section under subarachnoid space and epidural anesthesia.Methods Ninety pregnant women who scheduled cesarean delivery under subarachnoid space and epidural anesthesia were randomized divided into three groups:control group (30 patients) low-dose ketamine group (30 patients) and high-dose ketamine group (30 patients).0.9％ sodium chloride,0.25 mg/kg(3 ml),and 0.50 mg/kg (3 ml) ketamine were given in three groups before operation.The incidence of shivering and adverse effect were recorded respectively before anesthesia,after anesthesia 15 min and 30 min and after operation 1 h.Results The level of mean arterial pressure (MAP) in control group after anesthesia 15 main and 30 min and after operation 1 h[(62 ± 10),(58 ± 8),(61 ± 11) mm Hg(1 mm Hg =0.133 kPa)] were significantly lower than those in high-dose ketamine group [(78 ± 12),(82 ± 8),(76 ± 11)mm Hg] and low-dose ketamine group [(72 ± 10),(76 ± 6),(80 ± 7) mm Hg],there was significant difference (P ＜ 0.05).There was no shivering need treat in low-dose ketamine group and high-dose ketamine group.The rate of hallucinations and nystagmus in low-dose ketamine group [0,6.7％ (2/30)] was significantly lower than that in high-dose ketamine group [20.0％ (6/30),50.0％ (15/30)],there was significant difference (P ＜ 0.05).Conclusion The pretreatment with low-dose ketamine on shivering during cesarean section under subarachnoid space and epidural anesthesia has better preventive effectiveness,0.25 mg/kg of ketamine is more effective than 0.50mg/kg.

Objective To explore and assess the reasonable application of integrated collaborative service mode in obstetrics and gynecology clinical service.Methods 152 pregnant women admitted in obstetric outpatient from March 2016 to May 2016 were randomly assigned into observation group and control group,76 cases in each group.The control group received obstetric traditional outpatient treatment and hospitalization mode,while the observation group implemented the integrated collaborative service mode.It was a integrated mode based on the traditional mode and multidisciplinary professionals integrated into groups for synergistic services,from the beginning of pregnancy to discharge.Results The number of cases who were knowledged maternal diseases,intraoperative coordination,reasonable diet and breastfeeding of the observation group (69,70,69,66) were superior to those of the control group (51,40,54,50) (x2=17.56,52.58,12.44,11.11,all P<0.001).The incidence rate of maternal and neonatal complications of the observation group were significantly lower than those of the control group(t=12.04,6.49,2.87,9.26,-7.14,all P<0.005).And patients satisfaction survey was improved,the number of satisfaction and complaint in the observation group was 70 persons,1 person,which of the control group was 70 persons,6 persons (x2=7.65,P<0.01).Conclusion Integrated collaborative service mode can improve the quality of medical service and patients' satisfaction,while reduce cesarean section rate,postpartum hemorrhage and maternal complications.Integrated collaborative service mode is an effective method to promote the development of perinatal medicine.

Objective To explore the etiology, pathogenesis, syndrome differentiation and treatment for dengue fever according to the theory of traditional Chinese medicine ( TCM) . Methods A retrospective case analysis was carried out in 257 dengue fever patients admitted in 2013 by Guangdong Provincial Hospital of Traditional Chinese Medicine. The clinical data of pathogenic features, TCM symptoms and signs, and therapeutic regimen were collected and analyzed. Results Six commonly-seen TCM syndrome patterns for dengue fever were classified into disease involving both defensive system and Qi system, excessive heat in defensive system, summer-heat and dampness stagnating the middle-jiao or attacking the exterior, excessive heat in both Qi system and blood system, pathogenic factors lodging between diaphragm and pleura, and mixture of blood stasis and toxicity, and the corresponding prescriptions were Yinqiao Powder, Chaige Jieji Decoction, Xinjia Xiangru Decoction, Qingwen Baidu Decoction, Dayuan Decoction, Xijiao Dihuang Decoction, respectively. Conclusion The TCM syndrome patterns of dengue fever in Guangzhou area are characterized as excessive heat in Qi system, complicated with nutrient and blood system syndrome, and mostly are blended with dampness. Correspondingly, the therapeutic principles should be clearing heat and removing toxicity in Qi system with cold-cool herbs, and assisting with cooling blood to clear heat in Qi system and removing dampness.

Objective To evaluate the clinical effect of treatment for deep burn wound on finger by proper digital artery flap.Methods From March 2013 to October 2016, 24 patients with deep burn wound on finger were treated by proper digital artery flap.Postoperative observation included wound repair, flap survival, complications and functional recovery of fingers.Results All the 24 flaps survived and no necrosis happened.The marginal abnormal circulation of flap occurred in only 5 cases, which cured by dress changing.All flaps kept well in contour, skin color, temperature and texture.Movement function of donor and recipient fingers was nearly normal.Conclusion Proper digital artery flap avoided the deficiencies distant pedicled flap, so it is a favorite choice for digital soft tissue defect caused by deep burn injury.

Objective Investigate the effect of EC50 of propofol target-injection in the different TCM (traditional Chinese medicine) physique types of patients who are in unconscious phase. Methods Depend on the standard protocol of TCM physique types sort and determination, we sorted 60 patients into three groups:Ping He (group A), Yang Xu (group B) and Yin Xu (group C), 20 patients per group. We applied the sequential experiment to measure the minimal EC50 and NI values of propofol when the patients were in the unconscious phase. Results The EC50 of propofol of group A, B and C are 3.85 μg/mL, 4.12 μg/mL and 3.43 μg/mL respectively. 95% confidence intervals of group A, B and C are 3.64 ~ 4.07 μg/mL, 3.92 ~ 4.33μg/mL and 3.26 ~ 3.60 μg/mL respectively. Conclusion There is a correlation between the different TCM physique types and the dosage of propofol target-injection.

Educational reform of pathophysiology oriented to clinical application is to pass the physician qualifica -tion examination .One of essential approach is to implement pathophysiology teaching with the translational medical philosophy and promote the harmonious development of physician -patient relationship with the utilization of the de-velopment and changes of disease in the teaching process .In that way, the pathophysiology in basic and clinical medicine is worthy of the name of “bridge”, and ultimately achieves the goal of “the transformation and develop-ment of the cultivation of clinical application talents”.

In this study, CD133+ subpopulations were isolated from 41 primary colorectal cancer tissues, the proliferation and cell cycle distribution of the cells were examined without in vitro expansion, and then compared to those of cell lines. The detection of CD133 in colorectal cancer tissues, isolation of CD133+ and CD133- epithelial subpopulations, Ki-67/DNA multiparameter assay and cell volume analysis were flow cytometrically conducted. The results showed that Ki-67 expression was correlated with CD133 level in primary cancer tissues, while cell cycle G2/M phase distribution or clinicopathological characteristics was not. In addition, the CD133+ cells showed larger cell volume and higher Ki-67 expression as compared with CD133- cells. But there was no statistically significant difference in G(2)/M phase distribution between the two subpopulations. Our results demonstrated that the CD133+ subpopulation in colorectal cancer tissue contained more actively cycling and proliferating cells, which was not correlated to clinicopathological factors but might contribute to tumor progression and poor clinical outcome.

Objective To analyze the clinical features of patients with dengue fever (DF) accompanied by platelet count (PLT) reduction and their characteristics of traditional Chinese medicine (TCM) syndrome differentiation and treatment. Methods The clinical data of 1 570 patients with confirmed diagnosis of DF collected from the Information Management System (HIS) of the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (TCM) from January 2013 to December 2017 were retrospective analyzed. According to the patients accompanied by platelet (PLT) reduction or not, they were divided into DF accompanied by PLT reduction group (1 211 cases) and non-PLT reduction group (359 cases); according to whether the cooling blood and dissipating blood stasis TCM (composed of red peony, peony bark, rehmannia root, salvia miltiorrhiza, rhinoceros horn, etc.) was used or not in TCM syndrome differentiation prescription, they were divided into cooling blood and dissipating blood stasis group (492 cases) and non-cooling blood and dissipating blood stasis group (719 cases). The differences in clinical characteristics, laboratory indicators, TCM syndrome differentiation and prescription characteristics in DF accompanied by PLT reduction group and non-PLT reduction group were compared and analyzed; the differences in changes of white cell counts (WBC) and PLT levels before and after treatment between cooling blood and dissipating blood stasis group and non-cooling blood and dissipate blood stasis group were compared and analyzed. Results The proportions of rash, hemorrhage, WBC reduction and aspartate transaminase (AST) elevation in DF accompanied by PLT reduction group were significantly higher than those in non-PLT reduction group [rash: 61.4% (744/1 211) vs. 14.8% (53/359), hemorrhage: 7.3% (89/1 211) vs. 1.1% (4/359), WBC reduction: 88.2% (1 068/1 211) vs. 60.4% (217/359), AST increased: 41.0% (497/1 211) vs. 29.5% (106/359)]; the PLT and WBC in the DF accompanied by PLT reduction group were significantly lower than those in the non-PLT reduction group [PLT (×109/L): 74.2±27.5 vs. 166.6±42.8, WBC (×109/L): 2.1±1.6 vs. 6.4±3.7, both P < 0.05], and AST in the DF accompanied by PLT reduction group were significantly higher than those in the non-PLT reduction group (U/L: 69.6±34.1 vs. 52.6±26.1, P < 0.05). The common syndrome of TCM syndrome differentiation in DF accompanied by PLT reduction group and non-PLT reduction group was mainly Wei-Qi syndrome [425 cases (35.1%) and 147 cases (40.9%) respectively]; Yinqiao powder was the main TCM prescription in the two groups [132 cases (10.9%) and 46 cases (12.8%) respectively]. In the comparisons between the cooling blood and dissipate blood stasis group and non-cooling blood and dissipate blood stasis group, there were no statistically significant differences in the proportion of combining use of drugs for increasing WBC and PLT and the levels of WBC and PLT after treatment (all P > 0.05). After treatment, the WBC, PLT levels and the proportions of above indexes returned to normal in the cooling blood and dissipate blood stasis group were significantly higher than those in the non- cooling blood and dissipate blood stasis group [WBC(×109/L): 4.5±3.1 vs. 3.2±2.4, proportion of WBC returned to normal: 42.7% (210/492) vs. 33.1% (238/719); PLT (×109/L): 85.9±26.2 vs. 79.3±24.8, proportion of PLT returned to normal: 41.1% (202/492) vs. 27.5% (198/719), all P < 0.05]. Conclusions The symptoms of skin rash and bleeding are more common in patients with DF accompanied by PLT reduction. The syndrome differentiation of TCM for this disease is mostly based on the combined disorders of Wei (defence) and Qi, both Qi and blood burning and blood stasis associated with toxin. Cooling blood and dissipating blood stasis may help the recovery of WBC and PLT in these patients, which is of great significance in reducing severity of dengue fever (such as bleeding).