Objective To study the inhibition of growth and induction of differentiation of mouse B16 melanoma by acitretin and their mechanism.Methods Animal models of B16 melanoma were established by subcutaneously inoculation of cultured B16 cells into the right axilla of mice.All mice were divided into 5 groups,negative control group treated with peanut oil,low-dose acitretin group treated with acitretin 10 mg per kilogram of body weight per day,high-dose acitretin group treated with 20 mg per kilogram body weight per day,cisplatin group treated with cisplatin 10 mg per kilogram body weight,combination group treated with acitretin 20 mg per kilogram body weight per day plus cisplatin 10 mg per kilogram body weight.Acitretin was given daily via intragastric administration.and cisplatin was given with an interval of 7 days,from day 2 till day 22 after the inoculation.The growth of transplanted tumor was measured with an interval of 3 days.After drug withdrawal,mice were killed,transplanted tumors were obtained for the measurement of tumor weight,pathological examination and immunohistochemical staining for survivin,Fas and vascular endothelial growth factor(VEGF).Results Acitretin could significantly inhibit the growth of B16 melanoma,the average weight and volume of transplanted tumor in the treated groups were significantly lower than those in the negative control group(all P＜0.01).Pathological examination revealed that in the control group,tumor cells showed typical heteromorphism,and closely arranged with an obscure boundary,whereas in the treated groups,a massive or focal necrosis at different levels was observed in the center and margin of tumor tissue.The relative expression levels of suvivin,VEGF and Fas protein were 3.600±0.966,4.600±0.966,4.300±0.949 respectively,in high-dose acitretin group,2.100±0.568,2.400±0.516,5.900±0.730 respectively,in combination group,5.900±1.370,6.100 ±1.1 97,2.1 00±0.568,respectively,in the negative control group,and a significant decrease was observed in the expression of suvivin and VEGF in the former two groups along with an increase in Fas expression compared with the negative control group(all P＜0.01).Additionally,in all the treated mice,the expression of survivin was negatively correlated to that of Fas(rs=-0.77,P＜0.01),but positively to that of VEGF (rs=0.72,P＜0.01).Conclusions Acitretin can obviously inhibit the growth and induce the differentiation of B16 melanoma,which may be associated with its downregulation of survivin and VEGF expression as well as the upregulation of Fas expression.

Different subtypes of chronic hepatitis B virus(HBV)infection occurred clinically because of the status of virus’s interaction with immune system. In patients with immune tolerance,high level of HBV DNA was found,serum hepatitis B e antigen(HBeAg)was positive,and serum level of alanine aminotransferase(ALT)was normal with only mild or no inflammation in liver tissue. However,not all the patients with normal ALT were in immune tolerance status,the disease could progress insidiously and develop into liver cirrhosis. Whether these patients need anti-viral therapy has always been a hotspot of study. This article reviewed the correlation between immune status and HBV infection,the identification of patients with normal ALT but not in immune tolerance status,and the indication of anti-viral therapy for these patients.

Effective medical practice in the bio-psycho-social medical model calls for the doctor's narrative and communicative skills.The gradual application of narratives in medical practice and research facilitates the combination of narrative methods with medical science.The narrative medicine movement greatly promotes the narrative turn in the research of doctor-patient communication and provides a new perspective in medical humanities education.In the process of doctor-patient communication,the appropriate use of doctors' high narrative competence contributes to effective doctorpatient communication and helps to build a harmonious doctor-patient relationship.In medical education,the teaching strategy of combining classroom teaching with clinical probation teaching should be adopted to cultivate and enhance medical students' medical narrative competence.

Currently refractory and relapsed mantle cell lymphoma (MCL) continues to develope a poor prognosis, and the treatment remains a significant clinical challenge. The use of bortezomib in clinic provides a novel method for the treatment of refractory and relapsed MCL. This review summarizes the mechanism and efficiency of bortezomib in the treatment of MCL and the strategies for overcome of bortezomib resistance.

Primary lymphoma of bone (PLB) refers to non-Hodgkin lymphoma (NHL),which is an uncommon extranodal lymphoma,accounting for 1 % of all NHL,5 % of extranodal lymphoma and 7 % of primary bone tumor. Currently,the diagnostic criteria of PLB includes a primary focus in a single bone; positive histological diagnosis; and no evidence of distant soft tissue or distant lymph node involvement. The diversity,hereditery,and lower incidence of PLB make it difficult to diagnose. In order to decrease the rate of misdiagnosis and missed diagnosis,the clinical,pathological,and imaging characteristics of PLB in this study are analyzed.

It has been nearly 20 years from the discovery of hepatitis C virus (HCV)and clinical diagnosis of hepatitis C to antiviral therapy with interferon,and significant progress has been made.Substantial changes have taken place in both the concept and strategy for antiviral treatment of hepatitis C,with more and more direct-acting antiviral agents emerging in recent years;these changes are as follows:from the control of HCV to clinical cure,from a sustained virologic response (SVR)rate around 30%with conventional interferon therapy to an SVR rate of 70%-80% with standard therapy with pegylated interferon and ribavirin,and from evaluating the difficulty of treatment based on genotypes and viral load to determining the treatment strategy according to host IL28B genotypes and response patterns (rapid virologic re-sponse and complete early virologic response).The progress in antiviral therapy strategies for hepatitis C is systematically reviewed for re-understanding of refractory hepatitis C.

OBJECTIVE:To optimize the ultrasonic-assisted extraction technology of total flavonoids from Tibetan Scindapsus aureu. METHODS:The single-factor test was adopted to investigate the effects of extraction time,extraction temperature,the vol-ume fraction of ethanol,the ratio of liquid to solid and power on the extraction rate of total flavonoids from Tibetan Scindapsus au-reu in the process of ultrasonic-assisted extraction,based on which,four-factor and five-level Box-Behnken central component de-sign was performed with unchanged ultrasonic power,and then response surface method was adopted to analyze the effects of the 4 factors and their interaction on the extraction rate of total flavonoids to determine the optimal factor and level,and verification tests were conducted.RESULTS:The optimal ultrasonic-assisted extraction technology was as follows as extraction time of 29 min,tem-perature of 44 ℃,volume fraction of ethanol of 78%,ratio of liquid to solid of 13∶1(ml/g). In three verification tests,the aver-age extraction rate of total flavonoids was 2.130%,with an relative error of 0.005% compared to the theoretical value. CONCLU-SIONS:The optimal technology is reasonable and feasible,and can be used for theultrasonic-assisted extraction of total flavonoids from Tibetan Scindapsus aureu.

Objective To study the risk of pregnant women with epilepsy and its appropriate treatment. Methods A retrospective medical records review was conducted in 15 pregnant women with epilepsy at Peking Union Medical College Hospital from 1984 to 2004. The data were collected including maternal age at delivery, parity, gestational weeks at delivery, types of epilepsy, occurrence of seizures during trimester,mode of delivery and neonatal outcome. Results The prevalence of pregnancy with epilepsy was 0.06%. Six cases(40%)were aged 20～29, and 9 (60%) aged 30～36. There were 14 primigravidas, and 1 multiparity. One case delivered before 37 weeks and 14 after 37 weeks. The onset of epilepsy occurred before the age of 20 in 66.7% of women. During pregnancy, the number of occurrence of seizures increased in 5 patients (33.3%), decreased in 1 patient(6.7%), 9 cases(60%)were the same to non-pregnant period and 7 cases(46.7%)had no seizures. Ten women(66.7%) were on mono-medication, while 4 (26.7%) cases were on combined medication and 1 (6.6%) patient without medication. The Apgar′s score of all children was 10 at delivery and no congenital malformation was found. Two cases had breast-feeding postpartum. Conclusions Women with epilepsy should have prepregnant counseling. The lowest dose of antiepileptic drug (AED) and folic acid supplementation should be recommended before anticipated conception. During trimester, the blood concentration of AED should be closely monitored in order to adjust the dose. The prenatal outcome will be improved with proper management.

Objective To investigate the efficacy and safety of segmental electrical isolation of pulmonary veins (PVs) during atrial fibrillation (AF) Methods Nine patients were included, of whom 4 had recently persistent AF (3～4 months) and 5 suffored from paroxysmal AF occurred AF frequently We adopted one transseptal procedure Lasso mapping catheter and ablation catheter were positioned into target pulmonary vein ostium through the same site of atrial septum RF ablation was applied at the pulmonary vein potential (PVP) breakthrough using thermo control RF catheter during AF Results Twenty nine PVs were targeted for segmental RF ablation and isolated completely PVPs in target PVs were in higher spike and more frequent than left atrial potentials There were no complications associated with the procedure Seven patients were converted to sinus rhythm during the procedure Two patients restored sinus rhythm by cardioversion Conclusion It is suggested that the method of segmental PV isolation during AF is safe and has higher success rate It is not necessary to stop antiarrhymic drugs before RF ablation This study provides a reliable method for segmental electrical isolation of pulmonary veins in patients with persistent AF

OBJECTIVE To analyze the drug-resistance of Escherichia coli isolated from clinic in the past two years. METHODS The drug-resistance to 19 kinds of antimicrobial agents of 435 E. coli strains was detected by K-B method. 3-D test was performed to detect AmpC ?-lactamase and Extended-spectrum ?-lactamases(ESBLs). RESULTS It showed that the strains from cervical secretions, urine, throat swab and lochia specimens had the highest positive rate. Sensitivity test results showed that the resistance rate to ampicillin, aztreonam, sulfamethoxazole/trimethoprims and quinolones was high (49.23-84.10%), and resistance rate to the third, and fourth-generation cephalosporins was high too(31.35-46.80%). Strains that resistant to imipenem and meropenem were not detected out and they had a high sensitivity rate (93.38%), to cefoperazone/sulbactam. Detection rate of ESBLs and AmpC was 32.67% and 5.52%, respectively. Nineteen srtains produced both of them and 6 srtains produced AmpC only. CONCLUSIONS The detection rate and drug resistance are increasingly severe. Clinic and laboratory should make efforts to reduce hospital infection and dissemination of drug-resistant strains.