Objective To investigate the effects of ultrarapid opiate detoxification during general anesthesia on the plasma morphine concentration and brain ?-endorphin content in rats addicted to morphine. Methods Ninety male Wistar rats aged 12-15 weeks weighing 180-220 g were randomized into 6 groups: group I normal animal ( n = 5); group II morphine addiction ( n = 5); group III natural withdrawal ( n = 20); group IV general anesthesia ( n = 20); group V general anesthesia + naloxone ( n = 20) and group VI clonidine pretreatment ( n = 20). Morphine addiction was induced by subcutaneous injection of increasing doses of morphine sulphate for 5 days (5, 10, 20, 40 and 50 mg? kg-1 t.i.d. ? 5 days) . Morphine detoxification was started on the 6th day. General anesthesia was induced and maintained with ?-OH and midazolam i.m. supplemented with intermittent isoflurane inhalation to maintain loss of righting reflex. Spontaneous breathing was kept during general anesthesia. In group V naloxone 0.05, 0.1 and 0.2 mg was injected subcutaneously at 5, 30 and 60 min after loss of righting reflex. Successful detoxification was defined as no withdrawal symptoms after subcutaneous injection of naloxone 0.1 mg. In group VI clonidine 0.05 mg ? kg-1 was given i. v. 1 hour before induction of anesthesia. Blood samples and brain tissue were obtained before detoxification in group I (normal animal) and II (morphine addiction) while in the other 4 groups they were obtained immediately and 1,2,3 day after detoxification.Results The plasma morphine concentration was 224 ? 164 ng?ml-1 in group II (morphine addiction), significantly higher than in all the detoxification groups ( P V ) (P

Objective To compare the effect of Buzhong Yiqi Decoction (BYD) containing different doses of Radix Astragali on fibulin-3 expression in the hemorrhoid tissues of stage Ⅲ internal hemorrhoids patients with spleen deficiency and sinking of qi, and to evaluate its therapeutic efficacy and possible mechanism. Methods Fifty-five qualified patients were randomly divided into control group(N = 15), Chinese medicine group 1(N =20), and Chinese medicine group 2(N=20). All of the 3 groups were treated with operation, and additionally, Chinese medicine group 1 was given BYD containing Radix Astragali 20 g, and Chinese medicine group 2 was given BYD containing Radix Astragali 50 g orally after operation. The scores of anal pendant expansion and anal prolapse were evaluated, and the expression level of fibulin-3 in the hemorrhoid tissues was detected by Western blot method. Results After treatment, the symptoms of anal pendant expansion and anal prolapse were improved in the 2 Chinese medicine groups (P < 0.05) , and the improvement of anal pendant expansion symptom in Chinese medicine group 2 was superior to that of Chinese medicine group 1(P<0.05). Compared with the control group, the expression level of fibulin-3 in the hemorrhoid tissues of the two Chinese medicine groups was increased (P < 0.05); the expression level of Chinese medicine group 2 showed an increasing trend as compared with that of Chinese medicine group 1, but the difference was statistically insignificant (P > 0.05). Conclusion BYD with large dose of Radix Astragali exerts stronger therapeutic efficacy for the treatment of prolapsed hemorrhoids than BYD with small dose of Radix Astragali, and its therapeutic mechanism has no obvious relation with promoting the increase of fibulin-3 expression.

Medical education after graduation is the necessary step for each medical graduate to become an independent practitioner. The present medical education system or standardized residency training system in China is similar to that of the United States and Canada. This system is designed to ensure that all trained physicians are competent in practicing medicine in their trained medical specialties. The article briefly summarizes the current status of the pediatric residency and neonatal-perinatal medicine fellowship training system in the United States. The critical roles of the American Board of Pediatrics and the Accreditation Council for Graduate Medical Education are also presented.

Objective To investigate the clinical value of pregnancy-associated plasma protein A (PAPP-A) in patients with acute coronary syndrome (ACS).Methods The study subjects comprised of 249 patients with ACS [ 50 patients with ST elevation acute myocardial infarction( STEMI),43 patients with non-ST elevation acute myocardial infarction (NSTEMI), 156 patients with unstable angina pectoris (UAP) ] from July 2008 to December 2009 at Shanghai East Hospital affiliated to Tongji University.The patients were divided into single-vessel lesions group,double-vcssel lesions group and three-vessel lesions group according to the coronary artery stenosis.A group of 205 healthy subjects admitted for health physical examination were used as conuols.Blood samples were collected from ACS patients and control subjects.Serum PAPP-A,creatine kinaseisoenzyme MB (CK-MB),high-sensitivity troponin-T (hs-TnT) were measured by clectrochemiluminesence and high-sensitivity C-reactive protein (hs-CRP) was measured by immune scatter turbidity method.Analysis of variance ANOVA and Kruskal-Wallis H test were used for statistical analysis.Results Serum PAPP-A in the STEMI,NSTEMI,UAP and normal control group were 10.45(5.54 - 16.08),6.56(4.68 - 9.55),5.70(4.12 - 8.50),5.23 (4.00 - 5.88) mIU/L,respectively,and the difference was statistically significant (H =43.94,P ＜ 0.01 ).Pairwise comparison showed that PAPP-A in STEMI,NSTEMI,UAP were significantly higher than the healthy control group and differences were statistically significant ( t =6.80,2.46,1.72,P ＜ 0.05 ).The PAPP-A had a sensitivity of 52.2％ and specificity of 80％ in diagnosis of ACS.The positive rate of PAPP-A was 44.5％ (69/155) in patients with negative hs-TnT.The serum levels of PAPP-A in the three-vessel lesions group [7.72(5.03 -12.46) mIU/L] was higher than that in the single,double groups [ 5.35 ( 4.14 - 8.59 ),6.05 (4.42 -9.58 ) mIU/L ],and the difference had statistical significance( t =2.00,1.57,P ＜ 0.05 ).There was obvious correlation between the level of serum PAPP-A and the level of hs-CRP ( r =0.524,P ＜ 0.05 ),and there was weak correlation between the PAPPA and CK-MB or hs-TnT (r=0.326,0.343,P＜0.05).Conclusions The results shows that PAPP-A is elevated in patients with ACS.It may be used as a serum biomarker for vulnerable plaques in patients with ACS and has a clinical value for ACS diagnosis especially in patients with negative hs-TnT.

Objective To observe the influence of chitosan on the skin and soft tissue expansion.Methods Twenty-five patients were selected,who were suitable to be embedded soft tissue expanders in the face,a 100-milliliter expander was implanted in one side of the face,and other side was used as control.A 100-milliliter expander was implanted in each group,and a slender silicon duct was embedded between the expander and subcutaneous tissue in the experimental group.About five to seven days after the operation,the negative drainage tube was removed,and then two-milliliter medical chitosan injected with the silicon duct in the experimental group,but not in the control group.Two groups were injected with normal saline in the second day.The center of expanded skin was pressed and skin elasticity and relaxation were compared between the two groups during the injection interval.The time of injection interval,the quantity of normal saline inside the expanders after two weeks and three weeks and the total time of expansion to 100 milliliters were recorded.After injection was completed in the two groups and maintained for two weeks.In the stage Ⅱ operation,the expanders were taken out,1 cm × 1 cm fibropeplos was removed from the center of the expanded skin flap from the two groups,and pathological section was prepared to measure the thickness of fibropeplos,average gray scale of collagen and the quantity of blood capillaries.The fibroblasts,collagen fiber and capillaries were observed and compared under light microscope.A matched-pairs t analysis was used to analyze the data.Results Compared with the control group,the quantity of normal saline inside the expanders in the experimental group was increased at the same time; the water injection period was shorten and tissue expansion was significantly accelerated.The number of fibroblasts in the fibropeplos decreased with the influence of chitosan.The fibroblasts were restrained to mature period and collegan decreased.The fibropeplos became thinner but the capillaries were not affected.Conclusions Chitoson can inhibit fibroblast proliferation and collagen production,and the effect of accelerating tissue expansion is significant and deserves to be recommended.

OBJECTIVE: To explore the possible mechanism of Huoxue Qianyang Formula (HXQYF), a compound traditional Chinese herbal medicine, in reversing the left ventricular hypertrophy (LVH) of spontaneous hypertensive rats (SHRs) by analyzing the expressions of mRNAs and proteins of proto-oncogenes c-fos and c-myc in left ventricular muscle. METHODS: The experimental study was carried out in SHRs, the sex- and age-matched Wistar-Kyoto (WKY) rats were served as normal control (n=5, normal saline 10 ml/kg daily). Twenty-five SHRs were randomly divided into five groups: untreated group (n=5, normal saline 10 ml/kg daily), high-dose HXQYF-treated group (n=5, 0.84 g/ml HXQYF, 10 ml/kg daily), medium-dose HXQYF-treated group (n=5, 0.42 g/ml HXQYF, 10 ml/kg daily), low-dose HXQYF-treated group (n=5, 0.21 g/ml HXQYF, 10 ml/kg daily) and cilazapril-treated group (n=5, 1 mg/ml cilazapril, 10 ml/kg daily). The drugs were intragastrically administered once daily for 14 weeks. The expressions of mRNAs and proteins of proto-oncogenes c-fos and c-myc in left ventricular muscle were detected separately by in situ hybridization histochemical method and immunohistochemical method. RESULTS: Compared with the normal control group, the expressions of mRNAs and proteins of proto-oncogenes c-fos and c-myc in left ventricular muscle were significantly increased in untreated group (P<0.01). After treatment, the expressions of c-fos and c-myc mRNAs in left ventricular muscle in HXQYF-treated groups were significantly down-regulated as compared with those of the untreated group (P<0.05). The expressions of c-myc protein were also significantly decreased in high- and medium-dose HXQYF-treated groups as compared with the untreated group (P<0.05), but it had no significant effects in protein expression of c-fos in the three HXQYF-treated groups. CONCLUSION: HXQYF can inhibit the expression of c-myc in ventricular hypertrophy tissue, which may be the mechanism in treating LVH of hypertension.

OBJECTIVETo analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively.

METHODSA total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014. Method of treatment: scar contracture was conservatively released followed by skin grafting, which was referred to as method A; Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction, which was referred to as method B; traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contracture, and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months, which was referred to as method C. Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely. Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely. Method C was further used in patients when methods A and B failed to accomplish the expected result. Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release, and those who failed to meet the expectation were treated with method C in addition. Patients who were unwilling to undergo surgery were treated with method C exclusively. During the course of treatment, the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed. The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed. The length of palmar skin measuring from the root of finger with contracture to wrist crease was measured before treatment, at the termination of treatment, and 1 month after the termination of treatment. Scar condition was assessed with the Vancouver Scar Scale (VSS) before treatment and 1, 3, and 6 month(s) after the termination of treatment. Before treatment and 1 month after the termination of treatment, the range of motion was measured with the Total Active Movement (TAM) method; band function was evaluated by the Jebsen Test of Hand Function (JTHF), and the completion time was recorded. Data were processed with analysis of variance, LSD-t test, and t test.

RESULTSTwenty-four patients with 27 affected hands were treated with scheme A + B; 5 patients with 7 affected hands were treated with method C exclusively; 2 patients with 3 affected hands were treated with scheme A + B + C; 1 patient with 2 affected hands were treated with scheme C + A + C. During the course of treatment, no complication such as infection or slicing of tissue was observed, but there was a slight shifting of U-shaped Kirschner wire in 14 affected hands of 13 patients. Tendency of recurrence of scar contracture was observed in 11 affected hands of 10 patients, but the scar contracture did not reoccur after treatment with orthosis. The skin length of palmar side was respectively (131.8 ± 9.8) and (127.6 ± 7.5) mm at the termination of treatment and 1 month after, and they were both significantly longer than that before treatment [(114.5 ± 2.4) mm, with values respectively 10.71 and 10.39, P values below 0.001]. The score of VSS was respectively (9.8 ± 2.4), (9.7 ± 1.7), (9.3 ± 0.8), and (7.7 ± 0.5) points before treatment and 1, 3, and 6 month(s) after the termination of treatment. Only the score at 6 months after the termination of treatment was significantly lower than that before treatment (t = 3.28, P < 0.01). The ratio of excellent and good results according to method TAM was respectively 2.6% (1/39) and 94.9% (37/39) before treatment and 1 month after the termination of treatment. The time for JTHF measurement was (13.9 ± 4.1) min before treatment, and it was shortened to (11.0 ± 2.8) min 1 month after the termination of treatment (t = 3.65, P < 0.001).

CONCLUSIONSSingle application of metacarpus and phalanx traction or its combination with skin transplantation after scar release in correcting scar contracture of the palm of hand after burn can lengthen the contracted tissue, and it is beneficial for the restoration of function and appearance of affected hand.

Burns ; rehabilitation ; therapy ; Cicatrix ; therapy ; Contracture ; surgery ; Hand Injuries ; rehabilitation ; therapy ; Humans ; Metacarpus ; Orthotic Devices ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin ; Skin Transplantation ; Tendons ; Time ; Traction ; Treatment Outcome

Background Aniridia is a rare congenital hereditary eye disease.Studies determined that PAX6 gene mutation is closely associated with congenital aniridia,but the mutation locus are varied.Objective This study was to identify virulence mutation locus of PAX6 gene of a Chinese family pedigree with autosomal dominant aniridia.Methods A Chinese family affected with autosomal dominant aniridia was collected and examined in Affiliated First Hospital of Zhengzhou University in August 2014.Periphery blood of 10 ml was collected from all the families and 100 unrelated health controls.The genomic DNA was extracted by standardized phenol-chloroform method,and all exons and splicing junctions of PAX6 were amplified by PCR.Real-time fluorescence quantitative PCR was performed to examine the relative expression of PAX6 mRNA in patients and normal phenotype families and heahh controls.This study protocol was approved by Ethic Committee of Affiliated First Hospital of Zhengzhou University and complied with Helsinki Declaration.Written informed consent was obtained from subjects or custodian before any medical examination.Results This Chinese family inclued 3 generations and 9 members,with a classic autosomal dominant inheritance mode.Five patients were found,showing the absence of iris and cataract in 3 adult patients and only absence of the iris in 2 children,and other 4 members showed the normal phenotype.A novel heterozygous PAX6 deletion mutation c.796 del G (p.A266 fs) (GenBank ID:KP255960) in exon 10 was exclusively found in all affected individuals but not in any of the unaffected families or unrelated health controls.PAX6 mRNA level in lymphocytes was about 50％ lower in aniridia patients than in unaffected family members,indicating that this mutation caused nonsense-mediated mRNA decay.Conclusions A novel deletion mutation in PAX6 gene results in an abnormal PAX6 COOH-terminal extension in the Chinese aniridia family.This finding expands the mutation spectrum of PAX6 gene.

Congenital cataract is one of the important reasons for the blindness of children,and most congenital cataracts are genetic.At present,thirty-nine genes have been identified relating to autosomal dominant congenital cataract (ADCC).Objective This study was to identify and analyze the virulence gene of a Chinese family pedigree with ADCC by whole-exome sequencing.Methods A Chinese ADCC family was recruited in Affiliated First Hospital of Zhengzhou University from August to September in 2014.The family disease history and clinical data were recorded.The peripheral venous blood of 10 ml was collected in 14 patients with congenital cataract and 14 families with normal phenotype,and the peripheral blood samples were obtained from 100 healthy examined people as controls.The genomic DNA was extracted form all subjects using standard phenol chlorum method,and proband DNA was screened by whole-exome sequencing.Then mutation locus of the candidate gene was selected after compared with the information of database in the proband.The mutation locus of the candidate gene from 14 normal families and 100 healthy controls were amplified and sequenced by PCR technique based on the primer sequence of mutation locus of proband to verify the pathogenic gene of this ADCC family.This study protocol was approved by Ethic Committee of Affiliated First Hospital of Zhengzhou University and complied with Helsinki Declaration.Written informed consent was obtained from subjects or custodian before any medical examination.Results The family had a total of 5 generations of 68 members,in which 20 subjects were found with congenital cataract.The inheritance mode consisted with autosomal dominant inheritance.Cortical cataract was found in both eyes in the patients.Whole-exome sequencing showed that the 143rd ribonucleotide A of exon 2 explicit factor of chromosome 13 GJA3 gene mutated into G (c.143A＞G) in the proband,which resulted in the 48th amino acids changed from glutamate into glycine (p.E48G).PCR amplification product sequencing displayed that the same mutation of DNA appeared in all the patients of this family,while not the same mutation was seen in the candidate genes of normal phenotype families and 100 healthy controls.Conclusions GJA3 gene c.143A＞G is a virulence mutation site in this ADCC family,it is a supplement of the mutation spectrum of GJA3 gene.

Aim To observe the physical coupling between transient receptor potential channel vanilloid type 4 (TRPV4 ) and cPLA2 in endothelial cells. Methods We investigated the physical association of TRPV4-cPLA2 coupling by immunofluorescence reso-nance energy transfer (immuno-FRET)to assess the spatial proximity between TRPV4 and cPLA2 in human microvascular endothelial cells (HMEC),primary cul-tured endothelial cells and in thoracic aortas rings from high salt-induced hypertension mice.Results At the cellular level,with high salt treatment,the physical in-teraction of TRPV4 and cPLA2 was significantly en-hanced in primary vascular endothelial cells and HMEC.Furthermore, in thoracic aortas rings from high salt-induced hypertension mice,we found an in-creases interaction between TRPV4 and cPLA2 in en-dothelial cells from arterial segments .Conclusion High-salt treatment increases the endothelial TRPV4-cPLA2 coupling,indicating that this coupling may pro-vide a new target for vascular endothelial dysfunction.