OBJECTIVE:To provide new ideas for the supervision of TCM decoction for patients. METHODS:The mode of outsourced TCM decoction for patients in Nanjing and Hangzhou area were investigated and analyzed,especially their operation mode. The safety problems of quality of the mode were analyzed from the legitimacy and standardization. RESULTS & CONCLU-SIONS:The present problems include the mismatch of professional and technical personnel of TCM decoction pieces and their qua-lification requirements;the lack of communication of pharmacists and prescribers;no restrictions for outsourced decoction of toxic TCM decoction pieces for patients;the insufficient attention for the quality and safety of packaging materials;being difficult to im-plement the main responsibility of medical institutions,etc. It is suggested to establish the filing system of centralized TCM decoc-tion institution for patients;the stationed system of pharmacy technician in medical institutions;the training and evaluation system of dispensing,decocting and other stations;the regular inspection system of health and pharmaceutical administration department;the quality evaluation system of TCM decoction for patients by following up medical staff and patients. So that it can explore a new idea for monitoring ofclearing the powers of regulatory,full participation in medical institutions,standardization and management of pharmaceutical wholesale enterprises,active supervision by patients.

Objective To study the changes in small intestinal motility during the process of gallbladder cholesterol stone formation.Methods Forty guinea pigs were divided into two groups of 20 each,the experiment group fed on high cholesterol diet ( cholesterol 2％ ),while the control group on normal diet.Animals were sacrificed at 8 weeks.Slow wave and tension of the isolated small intestinal muscle specimen were measured using a multi-channel physiological recorder,and its relation to gallstone formation was assessed.Results Compared with the control group,the frequency and amplitude of the slow wave significantly reduced in the experimental group (5.70 ± 1.05/min vs.17.45 ± 1.50/min and 0.23 ± 0.31 my vs.0.78 ±0.17 mv respectively,P ＜0.05).The t-value between the two groups were -27.083 and - 13.236 respectively; Frequency of contraction and muscle tension also reduced significantly (5.94 ± 1.25/min vs.15.85 ± 1.76/min and 0.78 ±0.002 g vs.1.20 ±0.11 g respectively,P ＜0.05).Thet-value between the two groups were - 19.448 and - 17.307 respectively.Conclusions Reduced small intestinal motility is present in guinea pigs fed on a lithogenous diet,and may have a role in the pathogenesis of cholesterol gallstone formation.

Objective To investigate the effect of fluvastatin on ventricular remodeling and serum tumor necrosis factor alpha(TNF-α)level in elderly patients with acute myocardial infarction.Methods 87 elderly patients with acute myocardial infarction were chosen in Jiande Hospital of Integrated Traditional Chinese and Western Medicine from October 2014 to October 2016,were randomly divided into control group(42 cases)and observation group(45 cases),the control group received aspirin,PI Gray chlorine and other conventional treatment,the observation group were given fluvastatinon the basis of the control group treatment.The changes of cardiac function and serum inflammatory factor TNF-α levels were observed before and after treatment.Results After the treatment,left ventricular weight index such asleft ventricular systolic volume index,left ventricular diastolic membrane membrane volume index,left ventricular ejection fraction in the two groups were improved in different degree,but the observation group improved significantly(P<0.05).In the control group,there was no significant improvement; and after treatment,the indexes of the observation group were significantly better than those of the control group(P<0.05).The effective rate in the observation groupwas 93.33％,was significantly higher than the control group(P<0.05).After treatment,the levels of serum TNF-α were significantly improved in the observation group,and the level of serum was significantly decreased compared with before treatment(P<0.05),and the observation group after the treatment was obviously lower than the control group(P<0.05).Conclusion For elderly patients with acute myocardial infarction with fluvastatin can better improve the patient's heart function,improve the body's inflammatory level,effectively improve the treatment effect,inhibit ventricular remodeling.

Objective To investigate the value of MR imaging in detecting occult fractures. Methods Sixteen cases with acute trauma were studied using radiography and MR imaging, three cases also underwent CT examinations. Three fractures occurred in the femur condyle, 8 in the proximal tibia and 5 in the thoracolumbar spine. Results All sixteen cases had normal radiographic results. In 11 cases with femur condyle and tibia occult fracture, MR imaging demonstrated linear low signal in the subcortical region in 3 cases and irregular low signal from articular faces to shaft in 8 cases on both T 1WI and T 2WI, and high signal changes around low signal were seen on T 2WI, and the width of low signal was less than 4 mm on both T 1WI and T 2WI. The high signal in T 1 weighted-Fat saturated sequence was more remarkable and wider than that on T 2WI. 3 cases with CT scanning showed no fracture signs. In five cases with thoracolumbar vertebral occlut fractures, MR imaging demonstrated horizontal linear low signal in the center of vertebra on both T 1WI and T 2WI, and high signal changes around low signal were seen on T 2WI. Conclusions MR imaging could early determine the diagnosis of occult fractures. MRI should be the next examination of choice when plain films fail to reveal suspected fractures in the setting of suggestive symptoms and positive physical examination.

Objective To investigate and analyze the efficacy of intravenous levosimendan in the treatment of acute cardiac failure after cardiac surgery. Methods The study of the 80 cases of acute heart failure in patients undergoing cardiac surgery after treatment in March 2014 to March 2017, the patients were monitored in the treatment before and after treatment of 24 h heart rate, left ventricular ejection fraction, mean arterial pressure and central venous pressure and other related indicators. Results Of all patients, 58 survived after treatment, and 22 died during or after treatment. Compared with before treatment, after treatment of 24 h in left ventricular ejection fraction in patients, mean arterial pressure, central venous and changes in heart rate were significantly improved, data between the two groups had significant difference compared with statistical significance(P<0.05). In 8 patients, transient blood pressure reduction occurred during treatment, but symptoms disappeared after taking appropriate measures, and other patients had no more severe adverse reactions. Conclusion According to the method of intravenous levosimendan in treatment of acute heart failure in patients undergoing cardiac surgery after treatment can make the patient's cardiac function improved, has a significant effect on the prognosis of patients, should have a relatively high value.

Objective: The cytologic methods were used in the diagnosis of cancerous change of (intraductal papillomas,IP) and its significance was discussed. Methods： We studied the nipple discharge smear by using Wright-Gimsa staining. Meanwhile, infrared ray scanning B-ultrasound and X-rays were performed. Results： One hundred and twenty-eight patients were with IP， among them， 15 (11.7%)were confirmed as tumors by surgery and pathological examination. The cancerous change of cytomorphology was based on IP. The average age of patients with cancerous change was 48.1.The nipple discharge in patients with cancerous change was primarily bloody(66.7%). Conclusion： Introductal papillomas is carcerous. The possibility of canceration in persons with longer time of nipple discharge is larger than those with shorter time of nipple discharge. Women who are elder than 45 years old, with nipple discharge and post menopause, should be considered to have the possibility of cancerous change.

Objective To investigate the MRI features of children's joint tuberculosis of the appendicular skeleton, and to evaluate the diagnostic value of MR imaging. Methods Sixteen consecutive patients confirmed clinically and pathologically were examined with SE-T1WI, FSE-T2WI, FSE-PDWI and PD-SPIR in Philips Achieva 3.0T superconduct MR scanner. Axial, sagital and coronal images were obtained. Articular structure was all analyzed based on the affected parts and features of MRI. Results Hip joint and knee joint were most likely to suffer (each 25.00%). Metaphysis was affected in 13 patients with long signal intensity on T1WI and long signal intensity on T2WI. The changes of articular cartilage presented as abnormality of signal intensity in 6 patients with focal high signal intensity on T2WI. Thirteen patients presented as joint effusion. Synovial thickening in 4 patients showed moderate homogeneous signal on T1WI and slightly lower signal on T2WI. Articular soft tissue was involved in 16 patients, including the formation of cold abscess in 2 and cellulitis in 1 patient, showing long signal intensity on T1WI and long signal intensity on T2WI. Conclusion MRI has the advantage of being able to detect early abnormalities of bone marrow, cartilage damage and to evaluate joint effusion, synovial thickening and soft tissue lesions.

Background and purpose:Gemcitabine-based chemotherapy has been shown to have signiifcant activity and favourable safety in metastatic breast cancer patients, but the effectiveness is limited due to drug resistance. MicroRNAs are a family of small non-coding RNA molecules, acting as oncogenes or tumor suppressors. Although various mechanisms of chemoresistance have been uncovered, the aberrant microRNA expression and its relationship with drug resistance of breast cancer are still unclear. This study explored the potential role and underlying mechanism of microRNA-21 in gemcitabine resistant breast cancer. Methods:MDA-MB-231 cells were continuously exposed to the increasing concentrations of gemcitabine to induce drug resistance to gemcitabine, which was 10 times more resis-tant. Then multiple methods were used including real-time PCR (RT-PCR), CCK-8, Western blot, transfection, wound healing and Transwell assay to observe the effect of microRNA-21 on epithelial-mesenchymal transition (EMT) and chemosensitivity. Results:The expression of microRNA-21 was up-regulated in gemcitabine resistant breast cancer cell line and inversely correlated with gemcitabine sensitivity. Manipulation of microRNA-21 status could change microR-NA-21 level, and could result in corresponding changes in EMT status and drug sensitivity. Conclusion:MicroRNA-21 induces gemcitabine resistance possibly via EMT process in breast cancer.

Triple negative breast cancer (TNBC), as a special molecular subtype of breast cancer, is non-responsive to endocrine therapy or commercially available targeted therapy. It is characterized by early recurrence, rapid progression and poor prognosis. This systemic and comprehensive overview was focused on recent progress on molecular subtyping of triple negative breast cancer and its possible clinical value, chemotherapeutic agents and chemotherapy regimens, and combination of chemotherapy with potential molecular targeting agents.

Objective To obtain the lung adenocarcinoma initiating cells from the A 549 cell line based on paclitaxel treatment combination with serum-free cultivation and to validate spared cells can represent tumor initiating cells (TICs) .Methods After dis-sociated by trypsogen ,about 106 /mL cells were suspended in serum-free medium supplemented with 0 .4% bovine serum albumin (BSA) ,insulin ,basic fibroblast growth factor (bFGF) ,human recombinant epidermal growth factor (EGF) and obtained spheroid cells .At the second passage ,paclitaxel was added at a concentration of 100 nmol/L for 48 h and then replaced with completely fresh medium once or twice per week until new spheroids emerged .Results The subpopulation of cells that survived serum-free cultiva-tion and paclitaxel treatment could highly express the cluster of differentiation 133/cluster of differentiation (CD133/CD326) mo-lecular markers and have features of stemness including differentiation ,high expression of cancer stem cells (CSCs)-associated genes and stronger capability of tumorigenesis .Conclusion The survived subpopulation that highly express the CD 133/CD326 molecu-lar markers presenting the characteristics of stemness in vitro and in vivo ,and could be used in future researches of biological functions .