Objective To explore the absorption characteristics and mechanism of P-glycoprotein (P-gp) mediated transport of oleanolicacid (OA)across membrane in vitro.Methods The intake and transport of OA were evaluated by an HPLC/MS quantitative detection method.Safe concentration range of OA was determined by MTT.The effect of different drug concentration,incubation time,pH and temperature on the intake of OA by Caco-2 cells were investigated.The effect of P-gp inhibitor on the transmembrane transport of OA was investigated by the Caco-2 cell monolayer model,and the apparent permeability coefficient (Papp) was calculated.Results The uptake of O A was concentration-time dependent and correlated negatively to temperaturein Caco-2 cells within the safe concentration range,but was not significantly affected by pH value.Compared with controls,the Papp significantly changed when the P-gp inhibitor was added to the model(P ＜ 0.05).The apparent permeability ratio decreased from 2.90 to 0.95.Conclusion The absorption of OA was primarily by passive diffusion and might be mediated by the effiux by P-gp.

In order to investigate the application of par plana vitrectomy in the treatment of combined rhegmatogenous retinal detachment (RRD) and choroidal detachment (CD), 12 eyes of 12 cases of combined RRD and CD were retrospectively analyzed. Twelve eyes of 12 cases were subjected to par plana vitrectomy. Six mm infusion channels were used. Pars plana vitrectomy, membrane peeling and internal fluid－gas exchange with encircling scleral buckle placement were performed in a standard fashion. One patient received injection of silicone oil. Hormones were routinely administered pre- and post-operation. The results showed that the intraocular pressure was rapidly reconstructed in the 12 eyes of 12 cases, the fluid in the subchoroidal cavity was drained via the three sclera incisions. The detached choroidea replaced. No other sclera incision was needed to drain the fluid in the subchoroidal cavivity. The follow－up after operation lasted 2 to 16 months. The 12eyes were replaced anatomically. No postoperative proliferation of vitreous body and retina was induced. It was suggested that par plana vitrectomy was the first choice in the treatment of CD combined with RCD.

Objective To study the relation between the effect of Curcumin on the proliferation and activation of hepatic stellate cells(HSC)and the expression of the peroxisome proliferator-activated receptor?(PPAR?).Methods The rat HSC was isolated from SD rats through in situ perfusion of liver with Pronase E and density-gradient centrifugation with Nycodenz.The subcultured cells were treated with corresponding compound.The inhibition effect on HSC proliferation was determined by MTT colorimetry.The total RNA was extracted by TRizol reagent,and the gene expression level of PPAR? and smooth muscle actin (?-SMA)were determined by semi-quantitative RT-PCR.The total cellular proteins were extracted and separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis,and the protein level of ?-SMA was determined by Western blotting.Results The MTT analysis results showed that Curcumin inhibited HSC proliferation between 10 and 50 ?mol/L in a dose-dependent manner.In the Day 1,4,7 of primary HSC and passaged HSC,the expression of PPAR? mRNA decreased with HSC activation extent;Curcumin could up-regulate the expression level of PPAR?.Curcumin suppressed the expression of ?-SMA not only at the gene level but also at the translation level.But all these effects of Curcumin on HSC could be blocked by the PPAR? specific antagonist GW9662.Conclusion The effect of Curcumin on HSC cell proliferation and activation is through the up-regulation of PPAR? signal.

Aim To study the effect of Curcumin on the apoptosis of hepatic stellate cells (HSC), and the correlation between the effect and peroxisome proliferator-activated receptor ?(PPAR?) signal.Methods The HSC was isolated from normal SD rats through in situ perfusion of liver with protease E and density-gradient centrifugation with Nycodenz.The subcultured cells were treated with corresponding compounds. Cell apoptosis was detected by Hoechst 33258 staining. PPAR? subcellular distribution was detected by immunofluorescent staining. Total RNA, total protein and nuclear protein were extracted respectively, target gene and protein levels were determined by semi-quantitative RT-PCR or Western blot.Results There was nearly no apoptosis in activated HSC. Curcumin treatment induced the apoptosis of HSC, enhancing PPAR? nuclear translocation/redistribution.At the transcription and translation level,curcumin upregulated nuclear PPAR? expression, inhibited anti-apoptotic Bcl-2 expression, and promoted pro-apoptotic Bax expression; but all these effects could be reversed by PPAR? antagonist GW9662.Conclusions Curcumin induces HSC apoptosis by enhancing PPAR? expression and nuclear translocation/redistribution.

Objective To evaluate the efficacy of 2-year treatment of interferon alpha combined with lamivudine therapy in chronic hepatitis B patients. Methods From 1999 to 2001 87 patients were enrolled and randomized into two groups.36 patients received interferon alpha and lamivudine simultaneously for 26 weeks,then lamivudine alone for 76 weeks.51 patients received lamivudine alone for 104 weeks.The efficacy was evaluated by biochemical and virological parameters.The YMDD motif was detected in both groups. Results There was no difference between two groups in HBV DNA response ( P =0.24).Proportion of HBeAg/Anti-HBe seroconversion in combination group was significantly higher than lamivudine group (38.9% vs 17.6%)( P =0.03).HBV YMDD mutation rate in combination group was lower than in lamivudine group (22.2% vs 43.1%, P =0.04). Conclusion The efficacy of combination therapy appeares to be better than lamivudine monotherapy.Combination treatment may delay or diminish the development of HBV YMDD mutation.

Objective To investigate the preemptive analgesic effects of somato-visceral blockade in laparoscopic cholecystectomy (LC). Methods One hundred patients were randomly divided into four groups: Group A received peri-portal infiltration of 25 ml 0.25% bupivacaine (contained 1:200 000 epinephrine) before incision; Group B received intraperitoneal spray of 35ml 0.25% bupivacaine immediately after the establishment of pneumoperitoneum; Group C received the management of both Group A and Group B; Group D was control group without management. The extent and location of pain and nausea were recorded and assessed at 1, 2, 3, 6, 12, 24 and 48 postoperative hours, respectively. Results In the control group the incisional pain dominated over other pain locations within 24 hours postoperatively (P

Objective To investigate the effect of atorvastatin on the expressions of solubility P-selectin(sP-selectin) and high sensitive C reactive protein(hs-CRP) in patients with percutaneous coronary intervention (PCI),and to explore the protective effect of atorvastatin on myocardium.Methods A total of 100 acute coronary syndrome patients having underwent successful PCI were enrolled in this study.All patients were divided into 3 groups by random digits table method:standard treatment group (group A,30 patients,atorvastatin 20 mg),low-dose atorvastatin pretreatment group (group B,35 patients,preoperative 12 h and 2 h atorvastatin 40 mg and 20 mg,respectively) and high-dose atorvastatin pretreatment group (group C,35 patients,preoperative 12 h and 2 h atorvastatin 80 mg and 40 mg,respectively).The level of sP-selectin was measured with ELISA.The level of hs-CRP was measured with latex enhanced immunoturbidimetry.Results Before operation,the levels of sP-selectin in group A,B,C were (2.32 ±0.40),(2.51 ± 0.33),(2.47 ± 0.28) μ g/L.After 6 and 12 h of operation,the levels of sP-selectin in group A,B,C were (4.12 ± 0.75),(3.34 ± 0.42),(3.31 ± 0.46) μ g/L and (5.64 ± 1.07),(4.08 ± 0.74),(3.84 ±0.48) μg/L.The levels of sP-selectin in group A,B,C after operation were significantly higher than that before operation (P ＜ 0.05).At the same time point,the levels of sP-selectin in group B,C after operation were significantly lower than that in group A (P＜ 0.05).Before operation,the levels of hs-CRP in group A,B,C were (4.32 ±0.51),(4.46 ±0.57),(4.29 ±0.43) mg/L,after 6 and 12 h of operation,the levels of hs-CRP in group A,B,C were (8.91 ± 1.34),(7.44 ± 1.06),(7.28 ±0.95) mg/L and (13.66 ± 1.49),(8.08 ± 1.14),(7.92 ± 1.04) mg/L.The levels of hs-CRP in group A,B,C after operation were significantly higher than that before operation (P＜ 0.05).At the same time point,the levels of hs-CRP in group B,C after operation were significantly lower than that in group A (P ＜ 0.05).The analysis of Pearson correlation showed,the level of sP-selectin was positively related with hs-CRP (r =0.753,P ＜0.01).The incidence of perioperative myocardial infarction was 23.3％ (7/30),5.7％ (2/35) and 2.9％ (1/35) in group A,B and C,respectively.The incidence in group A was significantly higher than that in group B and C (P ＜ 0.05).But there was no significant difference between group B and group C (P＞ 0.05).Conclusion The atorvastatin pretreatment can decrease the levels of sP-selectin and hs-CRP in patients after PCI,which play an important role in myocardium protection.

The authors report one case of primary hepatic neuroendocrine carcinoma associated with multiple liver metastases. A patient was a 41-year-old female. In 2010, B-ultrasound examination revealed that there were multiple space-occupying lesions in the liver, and hepatic hemangiomas was considered to be the diagnosis. Then, the patient was followed up regularly. In Aug. 2013, B-ultrasound examination indicated that the hepatic lesions were significantly enlarged. Multi-detector CT scanning and MRI examination were performed, and still the diagnosis of multiple hepatic hemangiomas was suggested. On CT and MRI the lesion presented as a well-circumscribed hypervascular tumor with “fast-in and slow-out” enhancement pattern. On MRI, the lesion was characterized by multiple nodules. Needle biopsy was carried out, and the pathological and immunohistochemical diagnosis was metastatic neuroendocrine tumor. Systemic examination did not find the primary lesion. Therefore, primary hepatic neuroendocrine carcinoma associated with intra- hepatic metastases was diagnosed. The patient was treated with transcatheter arterial chemoembolization. The drugs used were 100 mg Oxaliplatin+one bottle of gelatin sponge particles(300-500μm)+10 ml iodized oil, and micro-pump infusion of 100 mg oxaliplatin(99 mg/h) through catheter was also employed. Clinically, primary hepatic neuroendocrine carcinoma is extremely rare. In combination with the medical literatures, the authors attempt to make a preliminary discussion on the clinical characteristics, differential diagnosis, treatment and prognosis of primary hepatic neuroendocrine carcinoma.

Objective To evaluate the possible causes of misdiagnosis of minimal breast carcinoma (MBC). Meth-ods The possible causes of misdiagnosis of 90 cases of MBC confirmed by pathology were retrospective analyzed. Accord-ing to the maximum diameter of the lesion, 90 cases were divided into 0.5-1.0 cm group (n=55) and≤0.5 cm group (n=35). And these two groups were subdivided into correct and misdiagnosed groups. The two-dimensional ultrasound findings were observed by using SIEMENZ S2000, GE vivid7 and GE vivid9 color Doppler ultrasound instruments, and reasons of misdiag-nosis were analyzed. Results There were 32 cases were misdiagnosed in 90 patients with MBC. There was significant differ-ence in boundary of misdiagnosis between diameter 0.5-1.0 cm group and≤0.5 cm group. There were significant differences in boundary and calcification between misdiagnosed group and correct group in diameter 0.5-1.0 cm group (P<0.05). There were also significant differences in A/T ratio and accompanying by multiple benign nodules between misdiagnosed group and correct group in diameter≤0.5 cm group (P<0.05). Conclusion The misdiagnosis in MBC is because of different lesion sizes. The misdiagnosis happens in the maximum diameter of the lesions between 0.5-1.0 cm that showed manifestation of sharp edges, no micro-calcification in sonographic features of benign. The misdiagnosis happens in maximum diameter of le-sions≤0.5 cm that manifested as the aspect A/T ratio<1 and characterized by multiple nodules.

Based on a review of research and application of the clinical decision support system (CDSS) at home and abroad,a KB-CDSS building model is proposed.The authors rounded up the architecture,principle,process,construction of the knowledge base,system design and application value of the system.In the end,the paper introduced the application of WanFang Data Clinical Diagnosis and Treatment Knowledge Base.