The occurrence, development and outcome of most diseases are a complex process. It is the advantage of traditional Chinese medicine to establish complex interventions that are consistent with the characteristics of disease development. The specific steps are as follows: quantitative research on literature research, establishment of interview framework; focus on interviews, specificization of interview outlines; semi-structured interviews, preliminary construction of complex intervention programs; evaluation of efficacy of complex interventions. The introduction of semi-structured interviews and other qualitative research methods into the modernization of traditional Chinese medicine, combined with quantitative methods such as text analysis and data mining, is also helpful in formulating the standard of diagnosis and treatment system with Chinese characteristics.

Objective To compare the safety and efficacy of the different doses of sufentanil combined with propofol target controlled infusion for modified electronic convulsive therapy ( MECT ) .Methods A total of 100 patients with mental disorders were randomly divided into four groups:control group (group C), sufentanil 1 group (S1), sufentanil 2 group ( S2 ) and sufentanil 3 group ( S3 ) , 25 cases in each group.In sufentanil groups, patients were respectively intravenously injected with 0.1, 0.2 and 0.3 μg? kg -1 sufentanil 10 mL, and those in control group were given 0.9%NaCl solution.Propofol was given through target controlled infusion, and the initial target density of 3.0 μg? mL-1 was set, and increased by 0.5μg? mL-1.When eyelash reflex disappeared, succinylcholine 1.0 mg? kg -1 was injected by intravenous injection.The vital signs of patients before anesthesia ( T1 ) , target control infusion stop immediately ( T2 ) , immediately after MECT finished ( T3 ) and consciousness recovery ( T4 ) , clinical effects,the seizure energy index, the seizure duration, awakening time, assisted ventilation time and adverse reactions were recorded.Results The difference had no statistical significance in vital signs, the seizure energy index, the seizure duration of all patients ( P >0.05 ) .Compared with group C, assisted ventilation in group S2 and S3 was prolonged, and the waking time was extended in group S3, total effective rate was increased in group S1 to S3 ( P<0.05 ) .Compared with group S1 , assisted ventilation time and waking time were extended, myalgia was decreased, and the total effective rate was increased in group S3(P<0.05).Compared with group S2 , the assisted ventilation was prolonged in group S3 ( P<0.05 ) .The incidences of nausea and vomiting and sleepiness were increased, while muscle pain and headache incidence were decreased as sufentanil dose increased. Conclusion Sufentanil combined with anesthesia of propofol target controlled infusion can be safe and effective for MECT, and 0.2 μg? kg-1 sufentanil is preferred.

OBJECTIVEThe study was designed to investigate the expression patterns of metalloproteinase (MMP)-13 protein in invasive breast carcinoma and to determine the clinicopathological and prognostic values of its various localization and relation to the tumor phenotypes.

METHODSImmunohistochemistry was performed on paraffin-embedded tissue array from 263 invasive breast carcinomas to investigate the protein expressions of MMP-13, estrogen receptor, progesterone receptor, HER2, MMP-2, MMP-9 and tissue inhibitor of matrix metalloproteinases (TIMP)-1, TIMP-2.

RESULTSMMP-13 protein was detected in the cytoplasm of carcinoma cells and peritumoral fibroblasts. High level expression of MMP-13 protein in tumor cells was associated with more lymph node involvement and higher tumor grade (both P < 0.01), and positively correlated with HER2 (P = 0.015) and TIMP-1 protein (P < 0.01) expression in carcinoma cells. Moreover, high expression of MMP-13 was associated with shortened overall survival for the entire patient population and the patient group with positive lymph node. Tumor cell derived MMP-13 had different impact on patients with different HER2 status. Peritumoral fibroblasts derived MMP-13 protein, although correlated with tumor cell derived MMP-13 and associated with lymph node stage and HER2 expression, was found having less prognostic impact. Univariate survival analysis showed that the tumor size, grade, lymph node status, PR status, HER2 expression, tumors TIMP-1 and MMP-13 expression were prognostic factors. However, multivariate survival analysis showed that only tumor size, lymph node status, HER2 expression, tumors TIMP-1 and MMP-13 were independent prognostic factors.

CONCLUSIONMMP-13 protein expressed by tumor cells correlates with the invasion and metastasis of breast carcinoma, and therefore, may serve as a poor prognostic marker for the patient.

Biomarkers, Tumor ; metabolism ; Breast Neoplasms ; metabolism ; pathology ; physiopathology ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Lymph Nodes ; pathology ; Matrix Metalloproteinase 13 ; analysis ; genetics ; Matrix Metalloproteinase 9 ; analysis ; Neoplasm Invasiveness ; diagnosis ; physiopathology ; Neoplasm Staging ; classification ; Prognosis ; Receptor, ErbB-2 ; analysis ; Receptors, Estrogen ; Receptors, Progesterone ; analysis

Chinese medicine processing is a kind of traditional pharmaceutical technology,which can reduce toxicity,enhance the curative effect,change the properties and facilitate dispensing preparations in clinical use.The technology of detoxification is a great pioneering work for the safe application of toxic Chinese medicine,which can reduce the side effects of certain drugs,ensure the clinical safe use and expand the scope of clinical application through processing.In this paper,we searched the toxic Chinese medicine and the processing technology in ancient literatures of TCM,and then we summarized and analyzed their lat-est studies at home and abroad.Thus,we make a summary of toxic Chinese medicine including its classification,site of action,the toxic components,detoxification and its clinical application.Meanwhile,we proposed an opinion that toxic Chinese medi-cines with the same processing technology had common detoxification rules.Therefore,we hope this work will provide new perspectives for the research on the processing of toxic Chinese medicine and the mechanism of detoxification.

OBJECTIVESTo investigate the effects of newborn bull serum(NBS), vitamin C and vitamin E on cryopreservation of mouse seminiferous epithelial cells.

METHODSThe seminiferous epithelial cells from 7-day-old mice were cryopreserved in different freezing solutions. The cell recoveries were examined by Trypan blue exclusive staining after thawing. The freezing solutions composed of DMEM, 10% dimethylsulphoxide(DMSO), and 0, 5%, 10%, or 20% NBS, respectively, or composed of DMEM, 10% DMSO, 10% NBS, and 150 micrograms/ml vitamin C or 50 micrograms/ml vitamin E, respectively.

RESULTSThe cell recoveries in freezing solution containing 0, 5%, 10%, or 20% NBS were 83.4%, 84.7%, 85.7% and 83.6%, respectively. There were no significant differences between them. The cell recoveries in freezing solution containing vitamin C or vitamin E were 88.0% and 82.9%, respectively. There was no significant differences compared with that in freezing solution containing 10% DMSO and 10% NBS.

CONCLUSIONSNBS, vitamin C and vitamin E have no significant protecting effects on mouse seminiferous epithelial cells, and can not significantly improve the cell recoveries.

Animals ; Ascorbic Acid ; pharmacology ; Cattle ; Cryopreservation ; Epithelial Cells ; physiology ; Fetal Blood ; physiology ; Male ; Mice ; Seminiferous Epithelium ; cytology ; Vitamin K ; pharmacology

The study aimed to investigate the impact of intraclot recombinant tissue-type plasminogen activator (rt-PA) on perihematomal edema (PHE) development in patients with intracerebral hemorrhage (ICH) treated with minimally invasive surgery (MIS) and the effects of intraclot rt-PA on the 30-day survival. We reviewed the medical records of ICH patients undergoing MIS between October 2011 and July 2013. A volumetric analysis was done to assess the change in PHE and ICH volumes at pre-MIS (T1), post-MIS (T2) and day 10-16 (T3) following diagnostic computed tomographic scans (T0). Forty-three patients aged 52.8±11.1 years with (n=30) or without rt-PA (n=13) were enrolled from our institutional ICH database. The median rt-PA dose was 1.5 (1) mg, with a maximum dose of 4.0 mg. The ratio of clot evacuation was significantly increased by intraclot rt-PA as compared with controls (77.9%±20.4% vs. 64%±15%; P=0.046). From T1 to T2, reduction in PHE volume was strongly associated with the percentage of clot evacuation (ρ=0.34; P=0.027). In addition, PHE volume was positively correlated with residual ICH volume at the same day (ρ ranging from 0.39-0.56, P<0.01). There was no correlation between the cumulative dose of rt-PA and early (T2) PHE volume (ρ=0.24; P=0.12) or delayed (T3) PHE volume (ρ=0.19; P=0.16). The 30-day mortality was zero in this cohort. In the selected cohort of ICH patients treated with MIS, intraclot rt-PA accelerated clot removal and had no effects on PHE formation. MIS aspiration and low dose of rt-PA seemed to be feasible to reduce the 30-day mortality in patients with severe ICH. A large, randomized study addressing dose titration and long-term outcome is needed.

OBJECTIVETo evaluate the outcome of emergency adult right lobe living donor liver transplantation for fulminant hepatitis.

METHODSNine cases of adult right lobe living donor liver transplantation were performed from September 2002 to August 2005, the clinical and follow-up data was analyzed.

RESULTSAccording to Child Pugh Turcotte (CPT) classification, 9 patients were classified as grade C before transplant. The Model for End-Stage Liver Disease (MELD) scores of these patients were 26.7 +/- 8.8. The principal pre-transplant complications included hepatic encephalopathy (5 cases), electrolyte disturbance (3 cases), renal failure (2 cases), gastrointestinal bleeding (1 case). The operations in donors and recipients were all successful. The post-transplant complications induced pulmonary infection in 2 patients, acute renal failure in 3 and transplantation related encephalopathy in 1. There were no primary graft non-function and no blood vessel and bile tract complications occurred. One-year survival rate was 55.6%. No serious complication or death found in donors.

CONCLUSIONSEmergency adult to adult living donor liver transplantation is an effective treatment for fulminant hepatitis but the safety of the donors should be assessed strictly preoperation.

Adult ; Critical Illness ; Emergency Medical Services ; Female ; Follow-Up Studies ; Hepatitis ; pathology ; surgery ; Humans ; Liver Transplantation ; methods ; Living Donors ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo immunopurify human endometrial endothelial cells (HEEC) from fresh surgical specimens of endometrial cancers and normal endometrial tissues, and investigate their biological characteristics.

METHODSEndothelial cells of endometrial cancers and normal endometrial tissues were isolated using anti-CD31 conjugated magnetic microbeads. The isolated endothelial cells were cultured in vitro and their origins were identified. Their angiogenic characteristics were observed by MTT, wound healing, Transwell cell invasion and tube formation assays.

RESULTSFlow cytometry revealed that the immunopurification technique yielded endothelial cell purity of > 95% in all samples. All purified HEEC were characterized as endothelial cells on the basis of expression of the classical endothelial markers vWF and CD31 as shown by immunofluorescence examination. Although the tumor-associated HEEC didn't show more rapid proliferation than normal HEEC, they exhibited enhanced migration ability (P = 0.006), potent invasiveness (P = 0.033), and elevated tube formation in vitro (P = 0.029).

CONCLUSIONSHuman endometrial endothelial cells can be efficiently isolated from endometrial cancer and normal endometrial tissues by immunomagnetic methods. Tumor-associated HEEC exhibit enhanced migratory ability, potent invasiveness, and elevated tube formation in vitro.

Adult ; Aged ; Cell Movement ; Cell Proliferation ; Cells, Cultured ; Endometrial Neoplasms ; metabolism ; pathology ; Endometrium ; cytology ; metabolism ; pathology ; Endothelial Cells ; metabolism ; pathology ; Female ; Humans ; Middle Aged ; Neoplasm Invasiveness ; Neovascularization, Pathologic ; Platelet Endothelial Cell Adhesion Molecule-1 ; metabolism ; von Willebrand Factor ; metabolism

OBJECTIVEViral hepatitis remains a major public health problem and the most common type of liver disease worldwide. There are an increasing number of patients with chronic hepatitis B who develop acute hepatitis on chronic condition (AOC) and die of acute hepatic failure both as a result of lack of understanding of the pathogenesis of the disease and lack of effective treatment. The hallmark of AOC is the extreme rapidity of the necromicroinflammatory process resulting in widespread or total hepatocellular necrosis in weeks or even days. Our previous studies have shown in an experimental animal model of fulminant viral hepatitis caused by murine hepatitis virus strain 3, the importance of macrophage activation, and expression of a unique gene mfgl 2 which encodes a serine protease capable of directly cleaving prothrombin to thrombin, resulting in widespread fibrin deposition within the liver and hepatocyte necrosis. The undergoing study in this report is designed to identify the role of hfgl 2 (human fibrinogen like protein 2) /fibroleukin in patients with viral hepatitis.

METHODSLiver tissues were obtained from 23 patients with AOC hepatitis B, and from 13 patients with inactive chronic hepatitis B (CHB) and 14 patients with chronic hepatitis B with cirrhosis during the year of 1995 to the end of 2001. Liver biopsies were performed within 30 min after the patients were diagnosed with death as a result of acute hepatic failure. Liver samples were also obtained from 4 liver donors as normal controls. In addition, peripheral blood mononuclear cells (PBMC) were isolated from 30 patients (unpaired) with AOC hepatitis B and 10 patients with CHB during the May of 2001 to March of 2002 and 10 healthy volunteer as negative control. PBMCs were freshly isolated and smeared on slides and kept at -80 degree C for further use. Histological sections were stained with hemotoxylin and eosin. A 169 bp of hfgl 2 cDNA probe and a polyclonal or monoclonal antibody against hfgl 2 were used to detect the expression of hfgl 2 mRNA and protein in liver samples as well as PBMC by immune histochemistry separately.

RESULTSLiver tissues from the patients with acute on chronic hepatitis had classical pathological features of acute necroinflammation. Hfgl 2 was detected by immune histochemistry in 21 of 23 patients (91.3%) in liver sections from patients with acute on CHB, while only 1 of 13 patients (7.7%) with CHB and cirrhosis and no evidence of active disease had hfgl 2 mRNA or protein expression. 28 of 30 patients (93.3%) with acute on CHB and 1 of 10 with CHB were detected with hfgl 2 expression in PBMC. There was no hfgl 2 expression in either the liver tissue or the PBMC from the normal donors. There was positive correlation of hfgl 2 expression and the severity of the disease displayed by the value of bilirubin and PT.

CONCLUSIONThe molecular and cellular results reported here in patients with acute on chronic hepatitis and who died of acute hepatic failure correlates with previous report in 8 patients with fulminant hepatic failure (FHF) and mimic closely the changes observed in the murine model of fulminant viral hepatitis in which the pathogenesis of the disease has been studied in a stepwise fashion. This study further suggests that virus induced hfgl 2 prothrombinase/fibroleukin expression and the potent function of the protein it encodes plays a pivotal role in initiating acute severe hepatitis on the baseline of chronic hepatitis. The measurement of hfgl 2/fibroleukin expression in PBMC may serve as a useful marker to monitor the severity of disease in patients with the AOC hepatitis B and a target for therapeutic intervention.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Fibrinogen ; biosynthesis ; genetics ; Hepatitis B, Chronic ; metabolism ; pathology ; Humans ; Infant ; Leukocytes, Mononuclear ; metabolism ; Liver ; metabolism ; pathology ; Male ; Middle Aged ; Prognosis ; RNA, Messenger ; biosynthesis ; genetics ; Severity of Illness Index ; T-Lymphocytes ; metabolism

OBJECTIVETo study the significance of supratubal recess and its aeration pathway to epitympanum in the pathogenesis of cholesteatoma otitis media.

METHODSFifty-two ears of cholesteatoma were selected as study group. Sixteen ears of traumatic facial palsy with pneumatic mastoid, which had no history of chronic otitis media were selected as control group. The status of supratubal recesses of all and their aeration pathways to epitympanum were observed in operations.

RESULTSSixteen ears from control group clearly presented supratubal recesses. Membrane closure was founded in four of them. The aeration pathways of fifty-two ears (100%) from study group were all completely closed. Comparing with control group, the difference was obviously significant (chi2 = 41.7144, P = 0.000). Among these cases, bony closure was observed in thirty-four ears (65.4%), while membrane closure in eighteen ears (34.6%). Their epitympanum space was very narrow and mastoid was sclerotic or poorly developed.

CONCLUSIONSBlockage of the aeration pathway between supratubal recess and epitympanum was possible one of the origins of negative-pressure status of epitympanum and mastoid, which might lead to the formation of aural cholesteatoma. Anatomy variation of the aeration pathway from supratubal recess to epitympanum might be a pathogenesis factor of cholesteatoma otitis media. It suggested that opening the aeration pathway in tympanoplasty with intact canal wall up technique might be helpful to prevent recurrence of aural cholesteatoma.

Adolescent ; Adult ; Aged ; Case-Control Studies ; Cholesteatoma, Middle Ear ; pathology ; Eustachian Tube ; pathology ; Facial Paralysis ; pathology ; Female ; Humans ; Male ; Middle Aged ; Young Adult