Inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2) and iNOS/COX-2 signal transduction path-ways are closely related to occurrence and development of diseases , such as tumor, immunity, inflammation, hypoxia, ischemia, injury and so on.iNOS/COX-2 controls the physiological and pathological activities of human lower urinary tract .This article summarizes the role and mechanism of iNOS/COX-2 signal transduction pathways in related diseases .It not only provids an important target for treat-ment of disease and but provides a theoretical basis and research ideas for the development and research of new drugs .

BACKGROUND: Collagen type Ⅰ possesses low antigenicity and provides special functions of scaffold structure for cell migration, proliferation and secretion.OBJECTIVE: To observe the morphological change after combination of transformed human embryonic tendon cells and artificial materials with collagen type Ⅰ, so as to provide the experimental basis for constructing tissue-engineered muscle tendon in vitro.DESIGN: Randomized and controlled observation.SETTING: Department of Orthopaedics, West China Hospital, Sichuan University.MATERIALS: This experiment was carried out at the Department of Transplantation Immunology, West China University of Medical Sciences from July to September 1998. Human hair, carbon fiber and polyglycolic acid were combined with collagen and then set corresponding groups respectively. Simply hair, carbon fiber and polyglycolic acid control groups were set respectively. Artificial materials: Healthy adult hair (30 cm in length, 80 g in weight), carbon fiber knitted strip (Lanzhou carbon factory )and polyglyolic acid fasciculi (Johnson , American) were used in this experiment.METHODS: ①In the group of human hair combined with collagen,nine healthy adult hairs were chosen . Three hairs as one bundle were knitted into tendon with 0.8 cm in length and 0.4 cm in diameter and a knot was tied respectively at the two ends. ②In the carbon fiber combined with collagen group, the purchased carbon fiber knitted strip was separated and made into artificial materials with the same diameter and length as those of human hair tendon. Two ends of the artificial materials were packed with 5/0 silk thread. ③In the polyglycolic acid combined with collagen group, three polyglycolic acid fasciculi were weaved into bundle with the same diameter and length as those of human tendon,and two ends were packed with 5/0 silk thread. ④The process of knitting scaffold materials was the same in control groups as in the corresponding experimental groups. ⑤ Five pieces were prepared in each scaffold material. After sterilized by 60Co, the scaffold materials were put in collagen type Ⅰ solution for 0.5 hour, then taken out and dried at roomtemperature for use in the experimental groups. ⑥transformed human embryonic tendon cell, density for 3×106/mm3, was used for combined culture in each group, and cell number and morphology were observed at different time points after culture under an inverted microscope and scanning electron microscope.MAIN OUTCOME MEASURES: ① Observation of cell growth and adherence under an inverted microscope ② Observation of cell morphology and material adherence under scanning electron microscope RESULTS: ① Observation of cell growth and adherenceunder an inverted microscope :In each experimental group, at two hours after culture, cells gathered around the materials, and some cells adhered to materials presented round; At three days after culture, the number of cells adhered to materials began to increase, morphology changed from round to oval, and the co-existence of round and oval cells was seen;While in each control group, at two and three hours after culture, few cells adhered to the three materials. On day five after culture, in each experimental group, cell morphology turned into fusiform, the number of cells increased further and a great many fusiform cells grew among carbon fiber materials; while in the control group, most cells presented round and ellipse, and the number of cells was less as compared with the corresponding experimental group. ② Cell morphology and material adherence under scanning electron microscope: On day 5 after in vitro culture, most tendon cells on the surface of materials presented spindle-shape in each experimental group. Apophysis stretched out from the tendon cells, grew along longitudinal axon of the materials. Silk and piece-like substance appeared among the apophysis and weaved each other. While there were fewer cells adhered in control group than in corresponding experimental group, cells also presented fusiform or round, but no silk or piece-like substance was found, also no apophysis appeared.CONCLUSION: Human hair, carbon fiber and polyglycolic acid combined with collagen type Ⅰ will facilitate cell adherence. Cells increase around the materials and co-existence of round and oval cells could be seen, and cells turned into fusiform, suggesting that exogenous collagen facilitate the cells to adhere onto the materials and proliferate.

Objective To investigate the distribution and effect of endothelial nitric oxide synthase (eNOS) on the zero-stress state of carotid arteries in rats at different ages.Methods Morphometry and microstructure of carotid artery in 3-month-old,6-month-old and 12-month-old Sprague-Dawley rats were studied quantitatively by histological method and computer image analysis.Immunohistochemistry and the NADPH-diaphorase reaction were used to localize the endothelial nitric oxide synthas (eNOS) in different age rats.The changes of opening angle in the zero-stress state was also observed.Results With increasing age,there was a significant reconstruction changes in morphometric parameters and microstructure parameters of the carotid arteries in rats.While the expression of eNOS protein of endothelium and vascular smooth muscle cells were decreased.Compared with 3-month-old rats,the zero-stress state.of opening angle in 6-month-old and 12-month-old group were increased.However,pre-incubation of vessel rings with L-arginine (30 mmol/L),a substrate of eNOS,attenuated the changes of the zero-stress state.Conclusions The results suggest that the carotid arterial wall in different age rats shows unequal growth and different zero-stress state eNOS may be involved in the age-related changes of zero-stress state of the carotid artery in aged rats.The results may provid an experimental base for vascular transplantation and vascular reconstruction.

Objective To observe the effect of kidney-tonifying herbal medicine (KTHM) on the changes of female rat genital system induced by Tripterygium wilfordii Hook(TWH).Methods Thirty female rats with normal oestrus cycle were randomly divided into 3 groups: control group,TWH group and TWH+KTHM group. The changes of genital system in all rats were examined after 90-day feeding. Results Compared with the TWH group,oestrus cycle was normal, estrogen and progestogen level and the weight of reproductive organs increased, the ovary was big,follicle grew well with more corpus luteum and good blood supplying, endometrium was thick with hyperplastic uterine gland,and vaginal epithelium became thick and cornificated in TWH+KTHM group. Conclusion Kidney-tonifying herbal medicine can antagonize the toxic and side effects of Tripterygium Wilfordii on the genital system of female rat.

Objective:To investigate the clinical therapeutic effect of low-dose chemotherapy in advanced gastrointestinal cancer patients with weak physical condition, and to evaluate the related factors affecting the prognosis.Methods:The clinical data of 118 advanced gastrointestinal cancer patients with weak physical condition who were admitted to Xiamen Branch, Zhongshan Hospital, Fudan University from March 2018 to May 2019 were retrospectively analyzed. Kaplan-Meier method was used to make survival analysis in patients stratified by different factors, and log-rank was used to test. Multiple factor analysis of prognosis was performed by using Cox regression model. The association of clinicopathological factors with the prognosis was evaluated.Results:Among 118 patients, 16 (13.6%) cases were esophageal cancer, 41 (34.7%) cases were gastric cancer, 48 (40.7%) cases were colorectal cancer, 13 (11.0%) cases were pancreatic cancer. The overall survival (OS) rates of 6 months and 1-year were 44.1% and 10.2%, respectively. Survival analysis showed that patients with hemoglobin ≥100 g/L, serum albumin > 40 g/L and normal gastrointestinal function had better OS (all P < 0.05), while patients with physical status score of 3 scores and pain had worse OS (all P < 0.05). Cox multivariate analysis showed that after adjusting age and gender, hemoglobin level ( HR = 0.314, 95% CI 0.241-0.977, P = 0.001), pain ( HR = 2.016, 95% CI 1.697-7.038, P = 0.008) and gastrointestinal function ( HR = 1.751, 95% CI 1.607-6.080, P = 0.036) were independent influencing factors of OS in advanced gastrointestinal cancer patients with weak physical condition after receiving low-dose chemotherapy. Conclusions:Low-dose chemotherapy can still benefit advanced gastrointestinal cancer patients with weak physical condition. Hemoglobin level, pain and gastrointestinal function are independent prognostic factors for these patients.

Objective To investigate the therapeutic effect of argon-helium cryoablation combined with transcatheter arterial chemoembolization (TACE) for primary hepatocellular carcinoma (HCC) and its influence on vascular endothelial growth factor (VEGF) level, and to compare it with simple TACE treatment. Methods During the period from Aug. 2013 to Aug. 2014 a total of 50 patients with primary HCC were admitted to Hunan Provincial People’s Hospital. The patients were randomly and equally divided into group A (TACE group, n=25) and group B (argon-helium cryoablation+TACE group, n=25). VEGF levels in the peripheral blood were determined before and after the treatment, and the results were statistically compared between the two groups. Results After the treatment the VEGF level in group A was significantly increased when compared with preoperative VEGF level (P<0.05). In group B, the VEGF level was decreased after the treatment, which was statistically significant lower than the preoperative VEGF level (P<0.05). The differences in VEGF level between the two groups were statistically significant (P<0.05). Conclusion The statistic analysis of VEGF levels indicates that argon-helium cryoablation combined with TACE is probably superior to simple TACE in the inhibition of tumor angiogenesis.

Objective To analyze the clinical characteristics of twin reversed arterial perfusion sequence (TRAP),and investigate its prenatal evaluation and clinical management.Methods Karyotype results and ultrasound data of 25 TRAP cases were retrospectively reviewed,including estimated weight and umbilical blood flow of acardiac twin,cardiac function and middle cerebral artery peak systolic velocity of pump twin.Various managements and the outcomes were analyzed.Results (1) Karyotype of amniotie fluid were tested in 16 pump twins.Mosaicism was found in 1 case (46,XX[36]/46,XY [14]).(2) According to the ultrasound evaluation,large acardia accounted for 87.0％ (20/23) cases.Abundant blood perfusion (inter-twin difference of umbilical resistance index ≤0.20) was indicated in 86.4％ (19/22) cases.Decompensation of cardiac function was suggested in 66.7％ (10/15) pump twins.Fetal anemia of pump twin indicated by middle cerebral artery peak systolic velocity＞1.5 multiples of the median was diagnosed in 75.0％ (12/16) cases.(3) The acardiac twin with abundant blood perfusion was more likely to be a large acardia than those without [94.7％(18/19) vs 1/3,Fisher exact test,P=0.04]; More pump twin with large acardia tended to have cardiac decompensation than non-large acardia pump twins [83.3 ％ (10/12) vs 0/3,Fisher exact test,P=0.02].(4) Eleven patients chose to terminate their pregnancies after being diagnosed.In 14 cases who continue the pregnancies,the survival rate of pump twin was 64.3％ (9/14).In 3 cases of non-large acardia without cardiac decompensation of pump twin,the patients selected conservative observation resulting in 2 term deliveries and 1 termination of pregnancy due to for exacerbation.Among 11 cases with large acardia,which the pump twins were complicated by cardiac decompensation or anemia,five cases selected conservative observation.One ended in spontaneous abortion; three exacerbated (one termination and two cesarean section before term with living births) ; one was stable until delivery.Another 6 cases received bipolar cord coagulation,and successful interruptions of acardiac blood flow were achieved in 5 cases among which 4 pump twins survived.Conclusions Prenatal diagnosis,cardiac function and fetal anemia of pump twin,together with the growth and blood supply of acardia are important indexes for prenatal evaluation of TRAP,on which our prompt management should be based.

The improvement of diagnostics teaching system,including the establishment of curriculum system and evaluation system,is the base of promoting clinical- medicine teaching.Our study showed that the theoretical knowledge and clinical skill of medical students could be improved by constructing clinical diagnostics curriculum system and improving organization management and assessment system,which could pave the way for the transition from medical students to clinicians.

Objective To investigate the intrauterine growth characteristics of twins and birthweight discordant twins (discordant twins ).MethodsTotal of 1010 twin pregnancies (2020 fetuses) with complete delivery records from the Department of Obstetrics and Gynecology,the First and Third Affiliated Hospital of SUN Yat-sen University between January 1,2000 and July 31,2010 were studied retrospectively.One handred and ninteen cases (238 fetuses) with intrapair birthweight difference ≥25％ were determined as the discordant twins group,and the other 891 cases (1782 fetuses) with intrapair birthweight difference ＜ 25％ were identified as the concordant twins group.The singleton control group included 4042 singleton pregnancies in the same period.Results ( 1 ) Comparison of clinical data between the twins groups:the birthweight of larger-twin,smaller-twin and intrapair birthweight difference in the discordant twins group and the concordant twins group were ( 2090± 827 ) g,( 1392 ± 592 ) g,( 33.9 ±9.3 ) ％,and ( 2408 ± 543 ) g,( 2191 ± 505 ) g,( 8.9 ± 6.5 ) ％,respectively,with significant differences (P＜0.01).The incidence of discordant twins was 11.78％ (119/1010).Compared with the concordant twins group,the discordant twins group bad higher proportion of monochorionic twins,and higher prevalence of pregnancy complications such as late miscarriage,abnormal umbilical insertion,twin-twin transfusion syndrome and hypertensive disorders in pregnancy ( P ＜ 0.05 ).( 2 ) The characteristics of twin birthweight distribution:① In all the 2020 twins,80.05％ (1617/2020) fetuses had birthweight below the 50th percentile of the singleton control group,while 23.71％ (479/2020) feeuses got birthweight below the 10th percentile of the singleton control group.② After 19th gestational week,the 50th and 90th percentile of all twins' birthweight were lower than those of singletons.After 38th gestational week,the birthweight of singletons kept increasing and reached its peak at 41 th week,while the birthweight of twins reached its peak at 38th week,followed by a decline at 39 weeks,which was even lower than the 10th percentile of the singleton control group.③ The distribution of birthweight of larger- and smaller-twin in the discordant twins group:65 (54.6％,65/119) larger-twins and one (0.8％,1/119) smaller-twin had birthweight above the 50th percentile of all twins,while 5 (4.2％,5/119) larger-twins and 97 ( 81.5％,97/119 ) smaller-twins got birthweight below the 10th percentile of all twins.Conclusions ( 1 ) The patterns of birthweight curves for each gestational week are different between twins and singletons.In order to evaluate the growth of twins, birthweight reference for twins shoull be employed.( 2 ) According to the reference of twins birthweight,the most discordant twins are complicated with fetal growth restriction at least in one twin.

Objective To summarize our preliminary experience of selective fetieide with bipolar coagulation in complicated monochorionie twins(MCT),and discuss the clinical application of feticide in discordant MCT.Methods Three MCT with one twin anomaly.in which 2 had severe twin-twin transfusion syndrome(TTTS),stage Ⅳ ,and 1 had acardiac twin,were identified in the second trimester of pregnancy.To terminate the abnormal twin and isolate the co-twin's circulation completely.selective feticide was performed by umbilical cord occlusion with bipolar coagulation under guidance of ultrasound and fetoscopy.After each invasive procedure,serial monitoring was performed,including procedural complications,Doppler of fetal middle cerebral artery and umbilical artery.Pregnancies were followed up every 2 weeks for fetal growth until delivery.After birth the placentas and the terminated fetuses were examined.Result Cord occlusion was successfully accomplished in all 3 targeted fetuses,at 21,22 and 24 weeks of gestation respectively.One case with TTTS was complicated with rupture of the membrane in the terminated fetus at the 7th day after the procedure.and a healthy baby was born at 32 weeks.The other case with TTTS delivered a boy by cesarean section at 38 weeks.The third case with TRAP is at 35 weeks of gestations and under regular follow-up.Monochorionicity was confirmed by placental examination after delivery.and the effects of bipolar coagulation were observed at the,cord of terminated fetuses.Conclusions Umbilical cord occlusion witll bipolar coagulation is an effective procedure for selective feticide in MCT with one twin anomaly.The outcome of normal fetus can be favorable.