Adult ; Delirium ; chemically induced ; Female ; Humans ; Thiocarbamates ; poisoning

Objective To study the characteristics of pharmacokinetics and pharmacodynamics of insulin dry powder inhalation and its relative bioavailability as compared with subcutaneous injection of regular insulin. Methods In this open,single-center,randomized,two-period,cross-over,euglycemic glucose clamp study,18 healthy volunteers(14 men and 4 women),aged(24.9?1.7)years,with body mass index(20.6?1.2)kg/m~2, received the insulin dry powder inhalatin(80 U)or regular insulin(15 U)subcutaneous administration.The blood samples of this study at 0,20,30,40,50,60,70,80,90,100,110,120,135,150,165,180,195, 210,225,240,270,300,330,360,390,420,450 and 480 rain were taken for serum insulin measurement, meanwhile,glucose infusion rates(GIR)were determined per 5 minutes over a period of 8 hours.Results The C_(max)were(57.9?17.8 vs 114.5?29.7)mU/L(tested vs reference preparation),T_(max)were(46.7?45.6 vs 107.8?33.7)min,GIR_(max)were(3.35?0.98 vs 5.17?1.75)mg?kg~(-1)?min~(-1)and T_(GIRmax)were(88.3?17.0 vs 151.9?34.6)min.The relative bioavailability was(10.26?2.25)%,and the relative bioefficacy was(14.33?7.26)%.Conclusion The study shows that insulin dry powder inhalation is absorbed via lungs and its action sets in earlier than that of the regular insulin injected subcutaneously.These pharmacokinetie and pharmacodynamic data may provide a reliabe guide for further clinical trial.

Objective To study the topoanatomy of anterior perineal plane and adjoining tissue structure in the preparation of ultra-low anterior resection of the rectum. Methods Dissection was performed on 16 male cadavers of semi-pelvis sectioned in the saggital plane. Eight indexes were measured and recorded. Results Anterior perineal plane was clearly found in all 16 cadavers. The median distance of rectum-urethra (R-U) was 14 mm (ranging 10 -17 mm). The contour of perineal body was trapezoid,which was narrow cranially and broad caudally. The median width of cranial perineal body was 8 mm (ranging 6 -9 mm), while the median width of caudal perineal body was 21 mm (ranging 18 -23 mm).The median numerus of thickness of perineal body (TPB), thickness of puborectalis (TPR), arrterior wall of rectum (aPR) -D, pPR-D and width of pelvic diaphragm (WPD) were 20. 5 mm ( ranging 17 - 23 mm),12 mm(ranging 10 -16 mm), 25 mm(ranging 21 -27 mm), 20 mm(ranging 16 -23 mm) and 8 mm (ranging 6 - 10 mm) respectively. Conclusions Anterior perineal plane clearly exists, through which about 20 mm more length of the distal rectum is available which could increase the sphincter-saving rate in cases of low rectal carcinoma.

Objective To study the effect of octreotide on patients with postoperative acute adhesive small bowel obstruction. Method In this study, 87 patients with postoperative acute adhesive small bowel obstruction were divided into 2 groups: experimental group (46 patients) and control group (41 patients). Patients in the control group were treated with routine therapy, including gastrointestinal decompression, intravenous infusion, antibiotic and enema. Patients in the experimental group were treated with routine therapy plus somatostatin analogue (octreotide) 0.1 mg. ih q8 h. for 72 hour. The alleviation of abdominal symptom and sign and the possibility of surgical intervention are observed and compared.Results Compared to the control group, the obstruction in the experimental group alleviated significantly,the abdominal pain relieved, the amount of draining decreased, and the passage of gas was earlier.Conclusions Based on the routine therapy, the use of octreotide significantly relieves the symptoms of obstruction and shortens the course of conservative therapy.

Objectives To study the expression patterns of steroid receptor coactivators (SRC) and steroid-induced stromal cell-derived factor-1 (SDF-1) in endometriosis,and to explore the roles of SRC in the steroid-induced SDF-1 expression endometriosis.Methods From May 2010 to October 2012,16 endometriosis cases at stages Ⅲ or Ⅳ according to the revised American Society for Reproductive Medicine classification undergoing surgery in the First Affiliated Hospital to Nanjing Medical University were enrolled in this study.Their ectopic endometrium were from ovarian endometriomata which were identified pathologically with 9 cases at proliferative phase and 7 cases at secretory phase.The normal endometrium were acquired from the healthy women with normal menstrual cycle (n =10,proliferative phase =5,secretory phase =5).The mnRNA levels of SRC and SDF-1α during the menstrual cycle were detected by quantitative real-time polymerase chain reaction.Ectopic endometrium stromal cells were purified and cultured in medium containing 17β-estradiol (10-8mol/L) or 17β-estradiol (10-8 mol/L) + progesterone (10-6 mol/L).At 24,48,72 and 96 hours,the supernatants were collected to measure SDF-1α expression by ELISA.Ectopic endometrium stromal cells were transfected respectively with siRNA of SRC-1 and SRC-2 using lipofectamine.Two days after transfection,17β-estradiol (10-8 moL/L) or 17β-estradiol (10-8 mol/L) + progesterone (10-6 mol/L) were added into the media.On the third day after the steroid hormones treatment,the media were collected to quantify SDF-1α expression with ELISA.Results (1) Cyclical changes: the SRC-1,SRC-2 and SDF-1 α showed marked cyclic differences in normal endometrium (P ＜ 0.05).In proliferative phase and secretory phase,the SRC-1,SRC-2 and SDF-1 α were 5.6 ± 1.2,3.8 ± 1.1,2.7 ± 0.5 and 2.6 ± 1.0,2.1 ± 1.0,1.6-± 0.5,respectively.There was no periodic variation in the expression of SRC-1,SRC-2 and SDF-1α in ectopic endometrium throughout the menstrual cycle.(2) Steroid-induced SDF-1α expression in ectopic endometrium stromal cells: the 17β-estradiol-induced SDF-1α expression was (1 803 ± 196),(2 272 ± 261) and (2 162 ± 258) ng/L at 48,72 and 96 hours.At the same time points,the SDF-1α expression induced by 17β-estradiol and progesterone was (1 307 ± 150),(1 518 ± 301) and (1 550 ± 144) ng/L,respectively.There was significant difference between two groups (P ＜0.05).(3) The effects of SRC silencing on steroid hormones-induced SDF-1 α expression in ectopic endometrium stromal cells: the expression of 17β-estradiol-induced SDF-1α at 72 hours was significantly decreased from (2 313 ± 357) ng/L to (1 155 ± 244) ng/L after the silencing of SRC-1 (P ＜ 0.05).After the silencing of SRC-2,the 17β-estradiol-induced SDF-1 α at 72 hours was (1 958 ±324) ng/L.There was no significant difference compared with the before the silencing (P ＞ 0.05).The expression of SDF-1 α at 72 hours induced by 17β-estradiol + progesterone was (1 534 ± 449) ng/L and (2 051 ± 380) ng/L respectively before and after the silencing of SRC-2 and showed the significant difference (P ＜ 0.05).Conclusion During the expression of SDF-1 α regulated by steroids in ectopic endometrium cells,SRC-1 is the major coactivator of 17β-estradiol and SRC-2 is the major coactivator of progesterone.

Objective To observe the effects ofXiaotan Sanjie Decoction on ultramicrostructure in MKN-45 human gastric cancer orthotopic xenograft;To discuss its mechanism for gastric cancer. Methods MKN-45 human gastric cancer cell line was used to establish subcutaneous tumor model in nude mice as an experimental model which passed three generations of tumor source. Then OB glue was used to establish human gastric cancer orthotopic xenograft model. 40 model nude mice were divided into control group, model group (received gavage with saline),Xiaotan Sanjie Decoction group (received garage withXiaotan Sanjie Decoction) and Tegafur group (received gavage with Tegafur), 10 mice in each group. Mice in the control group were under normal diet, without medicine intervention. After 6 weeks of treatment intervention, tumor weight was detected, inhibitory rate was calculated, the ultrastructural changes of gastric cancer cells were detected through transmission electron microscopy.Results The tumor weight inXiaotan Sanjie Decoction group was significantly lower than that in control group and model group (P<0.05,P<0.01). The tumor inhibition rate was 46.2%. Under the electron microscope, MKN-45 gastric cancer cells strain changed to typical apoptosis.ConclusionXiaotan Sanjie Decoction can lead to apoptosis effects on MKN-45 human gastric cancer orthotopic xenografts. All evidences indicate that inducing apoptosis may be one of the most important mechanisms ofXiaotan Sanjie Decoction in treating gastric cancer.

Objective To investigate the clinical effects of the modified Kock method of bladder re- construction with ileum,and to provide the objective basis for wide application of this technique.Methods A total of 51 patients with bladder cancer(T_2N_0M_0 stage tumor in 37 cases,T_3N_0M_0 stage tumor in 14; and pathologic gradeⅡ-Ⅲin all)were included.After radical cystectomy,modified Kock reconstruction of bladder with ileum was performed in them.The procedure consisted of preparing the segment of the ileum for reconstruction of the reservoir,anastomosing the low part of the neobladder with the urethra and regaining the original urinary conduit.Results The mean operative time was 6.5h(range,5.5-8.5h);mean in- traoperative blood loss was 650ml(range,300-1200ml),with blood transfusion in 31 cases.Perioperative complications included stress ulcer in 6 cases and urinary leakage in 1.The other 44 cases had no severe complications.Four cases died of cancer metastasis at 6-18 months after operation.During a follow-up of 8 -32 months,the other 47 cases recovered well and have been alive till now.Two cases had ureteral urine reflux with no impairment of renal function.The daytime urinary continent rate was 100%;and nocturnal uri- nary incontinence occurred in 6 cases.Conclusions The modified Koek reconstruction of bladder with il- eum can improve the patients'quality of life with fewer complications,therefore is a better treatment choice for infiltrative bladder cancer after radical eystectomy.

Objective To investigate the efficacy and clinical effectiveness of the steroid therapy with the all body and local application on hyperthyroid Graves ophthalmopathy.Methods A total of 57 patients (106 eyes)suffering from hyperthyroid Graves ophthalmopathy who hospitalized in the Department of Ophthalmology of the Second Affiliated Hospital of Harbin Medical University from Mar 2008 to Oct 2011 were enrolled in the study.Of the 57 patients,there were 21 males and 36 females,aged 18 to 57(average 37.28 ± 11.63).The clinical course was from 1 month to 5 years(average 29.63 ± 15.36 months).Based on the patient's age,sex and condition,the 57 patients were randomly divided into steroid pulse therapy with all body group(group SPT,29 patients,54 eyes)and peribulbar injection of long-term steraid group(group PI,28 patients,52 eyes).The patients in group SPT were treated with 0.5-l.0 g methylprednisolone by intravenous infusion daily for 3 days,and then stopped for 7 days,the treatment was repeated once.But the total application dose of methylprednisolone was not overruned 5.0-20.0 g.After that,the patients were treated with oral prednisone 40 mg/d.The dose of prednisone was reduced gradually to 5 mg/d.The total course of group SPT was 3 months.The patients in the group PI were treated with triamcinolone acetonide in periorbital injection of 20 mg once every two weeks for 3 months.After one month treated,all patients were visited.The patients' body weights of two groups were measured before the treatment and after one month treated.The ocular signs of the patients including visual acuity,diplopia,intraocular pressure,exophthalmos and horizontal visual palpebral fissure width were observed before and after the treatment.Results In the group SPT,the average body weight [(62.83 ± 7.23)kg]after the treatment was higher than that before the treatment[(57.03 ±7.13)kg],and also higher than that of the group PI[(59.89 ± 10.67)kg,t =25.25,2.08,all P＜ 0.05]after the treatment.In the group SPT,the average intraocular pressures before and after the treatment were (13.46 ± 1.78)and (13.69 ± 1.41)mm Hg(1 nm Hg =0.133 kPa),respectively.In the group PI,the average intraocular pressures before and after the treatment were (13.52 ± 2.19) and (13.77 ± 2.03)mm Hg,respectively.There was no significant differences before and after the treatment in both gr0ups(P＞ 0.05).In the group SPT and PI,the average exophthalmos after the treatment[(18.63 ± 2.22) and (14.85 ± 2.61)mm]were lower than those before the treatment[(20.78 ± 2.24) and (20.60 ± 2.81)mm,t =9.97,29.68,all P＜ 0.05],respectively.After the treatment,the average exophthalmos in the group PI was significantly lower than that of the group SPT(t =7.79,P＜ 0.05).In the groups SPT and PI,the average averagepalpebral fissure width after the treatment[(15.00 ± 1.80) and (11.65 ± 2.45)mm]were lower than those before the treatment[(17.22 ± 1.89) and (17.44 ± 2.37)mm,t =22.74,91.24,all P ＜ 0.05].After treatment of the group PI,the average exophthalmos was significantly lower than that of the group SPT(t =8.01,P ＜ 0.05).Conclusion Compared with the steroid pulse therapy with all body,the peribullbar application of long-term hormone for hyperthyroid Graves ophthalmopathy is more effective,with lcss side effects and worthy of promotion.

To verify the differential expression of non-metastasis cell 3 (NME3) protein in HL-60 cells when they were induced to differentiate into monocyte and granulocyte like cells, and study its value in diagnosis of acute myeloid leukemia, all-trans retinoic acid (ATRA) and a new steroidal drug NSC67657 were employed to induce acute myeloid leukemia HL-60 cells into monocyte and granulocyte like cells. Then the cell differentiating direction was observed by chemical staining, the degree of differentiation was determined by surface antigen CD11b/CD14 detection, and the apoptosis was excluded by phosphatidylserine valgus analysis, by which cellular differentiating model was constructed. Furthermore, RT-PCR and Western blot were employed to verify the differentially expression of NME3 before and after differentiation of HL-60 cells. At last, samples from bone marrow nucleated cells of 26 patients with myeloid leukemia, which were diagnosed definitely by clinical doctors, and 5 normal people were chosen. Then the expressing trend of NME3 protein in these testing groups was analyzed by means of comparison. The results showed that ATRA (2 µmol/L for 5 d) and NSC67657 (10 µmol/L for 5 d) could induce HL-60 cells to differentiate into monocyte and granulocyte like cells above 90% without cell apoptosis. The expression of NME3 gene and protein were down-regulated by the inducers, which was accorded with the screening results that was got using proteomics technology in the former research. The expression of NME3 protein in bone marrow from acute myeloid leukemia patients was elevated significantly as compared to normal persons. It is concluded that the expression level of NME3 protein is down-regulated after cellular differentiation, according with the changing trend in leukemia patients, which imply that NME3 protein may be a potential biomarker for diagnosis of acute myeloid leukemia.
Adolescent ; Adult ; Aged ; Bone Marrow ; metabolism ; Case-Control Studies ; Child ; Child, Preschool ; HL-60 Cells ; Humans ; Leukemia, Myeloid, Acute ; genetics ; metabolism ; Mesylates ; pharmacology ; Middle Aged ; NM23 Nucleoside Diphosphate Kinases ; metabolism ; Steroids ; pharmacology ; Tretinoin ; pharmacology ; Young Adult