Objective To understnad the defense mechanisms of patients with borderline personality disorder (BPD) and to explore its relationship with childhood abuses.Methods One hundred and forty-two outpatients with BPD (group A),63 outpatients with other personality disorders (group B) and 20 outpatients without any Axis Ⅱ diagnoses (group C) were enrolled and completed Chinese versions of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and the Defensive Style of Questionnaire (DSQ).Multivariate analysis of variance and Pearson correlation analysis were used for data analysis.Results Compared to group B and C,the score of defense mechanisms reported by group A were significantly increased in all eight premature defense mechanisms,such as projection(F =26.5,P ＜ 0.05),passive aggression (F =18.1,P ＜ 0.05),acting out (F =28.3,P ＜ 0.05),complaint (F =16.7,P ＜0.05),fantasy(F =16.3,P ＜ 0.05),splitting (F =28.8,P ＜ 0.05),withdrawal (F =8.3,P ＜ 0.05),somatization(F=7.6,P ＜ 0.05),and part of the middle defense mechanisms,such as omnipotence-devaluation(F =9.2,P ＜ 0.05),isolation(F =4.7,P ＜ 0.05) and identification (F =10.0,P ＜ 0.05).At the same time,the BPD patients got lower scores in the mature defense mechanisms,such as sublimation (F =4.1,P ＜ 0.05) and repression(F =3.9,P ＜ 0.05).Those who experienced physical abuse use more complaint (F =6.9,P ＜ 0.05),denial mechanisms (F =5.2,P ＜ 0.05) and less anticipation one (F =4.6,P ＜ 0.05).Those who experienced sexual abuse use more somatization (F =4.4,P ＜ 0.05) and isolation mechanism (F =3.6,P ＜ 0.05).Conclusions BPD patients would like to use more immature and middle defense mechanisms and less mature ones.Emotional,physical and sexual abuse from parents and other adult care takers have a correlation with immature defense mechanisms,which indicates the importance of care about parental rearing patterns and mental health of children.

Objective To evaluate the feasibility of and indications for laparoscopic left lateral hepatectomy. Methods The candidates for laparoscopic left lateral lobectomy were 7 cases with liver lesions including 2 cases of primary liver cancer,5 cases of liver hemangioma. Results These patients underwent laparoscopic hepatectomy uneventfully. The operation time averaged at 210 min. The blood loss in operation averaged at 700 ml. The postoperative hospital stay averaged at 5.7 days. No complications occurred. Conclusion Based on these preliminary results, we conclude that laparoscopic anatomical left lateral lobectomy can be carried out safely and effectively by a surgeon with the sufficient expertise of laparoscopy and hepatobiliary surgery.

To evaluate the automated segmentation algorithm for detection of intra - retinal layers to process images obtained from ultra- high resolution optical coherence tomography ( OCT ) . Graph theory and the shortest path search based on dynamic programming were applied to automatically segment the 8 intra - retinal layers. We experimentally verified the accuracy and reliability of the algorithm. The results showed that the intra-retinal layer boundaries between automated and manual segmentations matched well. The algorithm successfully segmented the intra- retinal layers in glaucoma, high myopia, and retinitis pigmentosa patients. The proposed automatic segmentation for intra-retinal layers provides a promising tool for quantitative analysis in clinical diagnosis and treatment.

Objective To investigate the potential influencing factors which possibly effected the gut barrier function.The effort was made to establish a clinical evaluation system of gut barrier dysfunc- tion.Methods Fifty-three critically ill patients with an APACHEⅡscore of 8 or more and 27 patient which APACHEⅡscore was 6 or less were recruited.Plasma was reserved for measurement of endo- toxin,tumor necrosis factor-?,diamine oxidase,D-lactic acid and high sensitive C reactive protein,uri- nary excretion of lactulose and mannitol and the urinary content of intestinal fatty acid binding protein (IFABP) were determined as well.Analyses was achieved by univariate,multivariate analysis and receiver operating characteristic curve.Results In the logistic regression models,gut barrier was affect- ed by many factors.The ratio of lactulose and mannitol in urine,the urinary content of IFABP of 24 hours and endotoxin level of plasma were identified as the most intimate factors which could associate with gut barrier function.The optimal operating point of plasma endotoxin,ratio of urinary lactulose and mannitol and content of urinary IFABP of 24 hours were 0.145,17 ng and 0,055 EU/ml respectively based on the results of receiver operating characteristic curve,the sensitivity and specificity were 84.5% vs 88%,78% vs 88% and 78% vs 78%.The doubtable value interval of urinary ratio of lactulose and mannitol was limited as 0.178 to 0.082.Conclusion Gut barrier dysfunction should be suspected when critically ill patients presented eertains gastrointestinal symptoms and had the proofs of increasing intesti- nal permeability,hypoperfusion of gut and higher level of plasma endotoxin.

OBJECTIVETo discuss the clinical effects of open reduction and internal fixation (ORIF) for treatment of patients with Lisfranc injury combined the second metatarsal base comminuted fracture.

METHODSFrom March 2007 to June 2012, 7 patients with Lisfranc injury combined the second metatarsal base comminuted fracture were treated including 5 males and 2 female aged from 22 to 51 years old (means 42 years), 4 of sprain and 3 of traffic injury. According Myerson classification, there was 1 case of type A, 3 of type B and 3 of type C. Kirschner wire was used to fix Lisfranc ligament placing from the medial cuneiform bone to the second metatarsal base during the operation. After the operation American Orthopaedic Foot and Ankle Society (AOFAS) criteria system were applied to evaluate the foot and ankle function. Preoperative and postoperative AP, lateral and oblique X-ray and CT scan were collected for radiographic evaluation.

RESULTSAll patients were followed up from 12 to 20 months (16.8 months in average). According to AOFAS criteria system, 3 cases were excellent result,3 good, 1 fair. All the wounds were primary healing without skin necrosis, infection, Kirschner loose,broken, or other complications.

CONCLUSIONKirschner wire had good clinical efficacy for fixing Lisfranc ligament injury with the second metatarsal base comminuted fracture, and could avoid arthrodesis.

Adult ; Bone Wires ; Female ; Humans ; Male ; Metatarsal Bones ; injuries ; surgery ; Middle Aged ; Tarsal Joints ; injuries ; surgery ; Wound Healing

Objective To investigate the clinical features and electron transfer flavoprotein dehydrogenase (ETFDH) gene mutations in 35 Chinese patients with lipid storage myopathy. Methods The clinical data of 35 cases with lipid storage myopathy confirmed by muscle biopsy were collected. The sequences of all 13 exons of ETFDH were analyzed. Results All 35 patients showed proximal weakness. Ten of them demonstrated masseter weakness and 28 of them showed weakness in neck flexion. Twenty-nine of 32 patients who were followed up showed improvement after treatment with VitB2 and CoQ10. Mutations of ETFDH were found in 30 of 35 patients,which included 8 homozygosises,20 compound heterozygosises and 2 single heterozygosises. Fourteen novel mutations were found, including 9 missense mutations ( c. 3G > C, c. 152G>A, c. 191G > A, c.349G>C, c.433G>C, c. 949C > A, c. 1454C > G, c. 1744A >T and c. 1763A>G), 1 nonsense mutation(c. 172G>T), 2 deletions(c. 1282_1283del and 1773_1774del) and 2 splice mutations (c. 405 + 1G > T and c. 1691 -3C > G). Nine of them showed c. 250G > A mutation and 6 of them showed c. 770A > G mutation. Conclusions Lipid storage myopathy is presented as proximal weakness. Multiple acyl-CoA dehydrogenase deficiency caused by mutations of ETFDH is the major cause of lipid storage disease in this group. ETFDH c. 250G > A and c. 770A > G mutations show a high frequency.

OBJECTIVETo assess the influences of continuous femoral nerve block (CFNB) and patient-controlled intravenous analgesia (PCIA) on postoperative pain scores,knee rehabilitation,and stress response after total knee arthroplasty (TKA).

METHODSTotally 32 adult patients scheduled for elective total knee arthroplasty were equally randomized into CFNB group or PCIA group. Intraoperative hemodynamics and fentanyl dose were recorded. Pain was assessed at rest and during continuous passive motion (CPM) using a visual analog scale at post-anesthesia care unit (PACU) and 4, 8, 12, 24, and 48 hours postoperatively. Morphine consumption was also recorded. As indicators of stress and inflammatory response,the leukocyte count, serum lactic acid, blood glucose, serum C-reactive protein (CRP), and serum cortisol were determined on admission, to operation room, immediately after skin incision, before extubation,on post-operation day 1 (POD1), and on POD2.

RESULTSCFNB group showed significantly lower heart rate compared with PCIA group 60 minutes and 90 minutes intraoperatively (Pü0.05). Intraoperative consumption of fentanyl was significantly lower in CFNB group (137.5∓44.4) μg than in PCIA group (264.1∓67.1) μg (Pü0.01). The CFNB group showed significantly lower VAS scores both at rest and during CPM compared with PCIA group at all time points (Pü0.05). Morphine consumption was significantly lower in CFNB group than in PCIA group at different time points (Pü0.05 or Pü0.01). The maximal continuous passive motion amplitude of CFNB group were significantly larger than that of PCIA group on POD1 [(55.0∓9.4) vs.(44.6∓9.9), P[(76.3∓11.0) vs. (67.5∓10.3), P<0.05]. The incidences of somnolence and nausea/vomiting in CFNB group were 37.5% and 37.5%, respectively,which were significantly lower than those of PCIA group (75.0% and 81.3%) (Pü0.05). Patient satisfaction scores on anesthesia and post-operative analgesia was significantly higher in CFNB group than in PCIA group (93.1∓7.9 vs. 79.1∓11.9, respectively) (Pü0.05).

CONCLUSIONAfter TKA,CFNB technique provides more stable intraoperative hemodynamics than PCIA, with better pain relief,faster postoperative knee rehabilitation,less side effects,and higher patient satisfaction.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesia, Patient-Controlled ; methods ; Arthroplasty, Replacement, Knee ; Female ; Femoral Nerve ; Humans ; Male ; Middle Aged ; Nerve Block ; methods ; Young Adult

OBJECTIVETo construct tree models for nasopharyngeal carcinoma (NPC)and explore the oncogenesis process of NPC.

METHODSBased on the software which Desper et al developed, tree models were constructed for colorectal carcinoma (CC) from the comparative genomic hybridization (CGH) data of 118 CC patients and for NPC from the CGH data of 140 southern Chinese patients, respectively.

RESULTSTree models for CC suggested that changes in -18q and +20q were important early events in colorectal carcinogenesis. As changes in -18q occurred prior to those in -17p, there might be some cause-effect relationship. Tree models for NPC suggested that change in -3p was an important early event in nasopharyngeal carcinogenesis, and those in -11q, -14q, -16q, -9p were also non-random genetic events in carcinogenesis, suggesting that there might be tumor-associated genes existing on these chromosome arms. The tree model also suggested the existence of oncogene on the short arm of chromosome 12.

CONCLUSIONConstructing tree models based on the CGH data to demonstrate the initiation and progression of NPC might help elucidate its multigene, multistep and multipathway development. It may provide valuable clues to explore the mechanism of tumorigenesis.

Chromosome Aberrations ; Colorectal Neoplasms ; etiology ; genetics ; Humans ; Nasopharyngeal Neoplasms ; etiology ; genetics ; Nucleic Acid Hybridization

UNLABELLEDTo screen and analyze the apoptosis- and proliferation-related genes in human nasopharyngeal carcinoma (NPC).

METHODSAccording to gene ontology classification, the abnormal expressions of the genes related to cell apoptosis and proliferation were identified in the NPC gene chip data. The cell apoptosis- and proliferation-related genes expressed in each of the 3 stages, as defined by the tree model for the pathogenesis and progression of NPC, were screened, and with literature review, their distribution in the tree model were analyzed.

RESULTSNineteen genes related to cell apoptosis were found in NPC, among which 9 were down-regulated (such as DNASE1L3) and located in the chromosome deletion regions, and 10 were up-regulated (such as DEDD) in the chromosome amplification regions. Twenty-one cell proliferation-related genes were identified, including 8 down-regulated genes (such as TUSC2) in the chromosome deletion regions and 13 up-regulated ones (such as EMP1) in the chromosome amplification regions. In the chromosome deletion regions, the down-regulated cell apoptosis-related genes participated mostly in inducing and regulating cell apoptosis, and the up-regulated cell proliferation-related genes in the chromosome amplification regions were mostly associated with the positive regulation of cell proliferation.

CONCLUSIONNPC occurs possibly through two pathways by inhibiting cell apoptosis or by promoting excessive cell proliferation.

Apoptosis ; genetics ; Cell Proliferation ; Chromosome Deletion ; Down-Regulation ; Gene Expression Profiling ; Humans ; Nasopharyngeal Neoplasms ; genetics ; pathology ; Oligonucleotide Array Sequence Analysis ; Up-Regulation

Many antineoplastic agents can cause myelosuppression and thrombocytopenia. Thrombopoietin (TPO) is believed to be the major cytokine affecting the proliferation and maturation of megakaryocytes and increasing circulating platelet levels. We have designed and synthesized a TPO mimetic peptide, it can increase circulating platelet levels in vivo. For increasing half-life and forming dimer, the peptide was expressed as chimeric proteins with human IgG1 Fc fragments. The cDNA of TPO mimetic peptide was synthesized chemically and linked respectively to 5' terminus of human IgG1 Fc cDNA fragments in various length (Fc1: Fc 5' 648 bp; Fc2: Fc 5' 270 bp; Fc3: Fc 5' 267 bp; Fc4: Fc 5' 90 bp), and cloned into expression plasmid pET28a (+) for constructing four recombinant plasmids. By transforming the four recombinant plasmids into E. coli. BL21 (DE3) respectively, we got 3 kinds of engineered E. coli which express TPO + Fc chimeric proteins(28 kD TPO + Fc1, 12 kD TPO + Fc2 and 12 kD TPO + Fc3) at high level respectively, the expressed proteins were purified with DEAE-Sepharose FF and S-Sepharose FF column. The bioactivities of the expressed chimeric proteins(TPO + Fc1, TPO + Fc2 and TPO + Fc3), TPO mimetic peptide, and PEG4000 coupled TPO mimetic peptide were evaluated with Ba/F3-mp1 in vitro and with carboplatin-induced thrombocytopenia mice in vivo, the expressed chimeric proteins have higher activity than TPO mimetic peptide both in vitro and in vivo, the EC50 on Ba/F3-mp1 cells were 13, 10, 10, 50, and 25 nmol/L respectively, all of them can increase circulating platelet counts. Their imol/Lunogenicity were valuated in mice, none of them can elicit mice to produce antibodies to TPO mimetic peptide, meanwhile three TPO + Fc chimeric proteins can elicit mice to produce antibodies to human IgG1 Fc. These studies have laid basis for production of TPO mimetic peptide by genetic engineering.
Animals ; Base Sequence ; Blood Platelets ; drug effects ; Cell Division ; drug effects ; Female ; Humans ; Immunoglobulin Fc Fragments ; genetics ; immunology ; pharmacology ; Immunoglobulin G ; genetics ; Male ; Mice ; Mice, Inbred BALB C ; Molecular Sequence Data ; Oligopeptides ; chemical synthesis ; genetics ; pharmacology ; Recombinant Fusion Proteins ; genetics ; immunology ; pharmacology ; Thrombocytopenia ; blood ; immunology ; Thrombopoietin ; genetics ; immunology ; pharmacology