大柴胡汤证病机新探

传统观点认为,大柴胡汤是治疗少阳阳明合病的方剂。但笔者结合《伤寒论》和《金匮要略》中大柴胡汤有关条文以及本方剂的药物组成,重新探讨大柴胡汤证的病机,认为本方证的病机是胆热郁甚为本,脾胃气机壅塞为标。

Two-sample Mendelian randomization analysis of causal relationship between eczema and autoimmune diseases

Objective:The causal relationship between eczema and autoimmune diseases has not been previously reported.This study aims to evaluate the causal relationship between eczema and autoimmune diseases.Methods:The two‐sample Mendelian randomization(MR)method was used to assess the causal effect of eczema on autoimmune diseases.Summary data from the Genome-Wide Association Study Catalog(GWAS)were obtained from the Integrative Epidemiology Unit(IEU)database.For eczema and autoimmune diseases,genetic instrument variants(GIVs)were identified according to the significant difference(P<5×10−8).Causal effect estimates were generated using the inverse‐variance weighted(IVW)method.MR Egger,maximum likelihood,MR-PRESSO,and MR-RAPS methods were used for alternative analyses.Sensitivity tests,including heterogeneity,horizontal pleiotropy,and leave-one-out analyses,were performed.Finally,reverse causality was assessed.Results:Genetic susceptibility to eczema was associated with an increased risk of Crohn’s disease(OR=1.444,95%CI 1.199 to 1.738,P<0.001)and ulcerative colitis(OR=1.002,95%CI 1.001 to 1.003,P=0.002).However,no causal relationship was found for the other 6 autoimmune diseases,including systemic lupus erythematosus(SLE)(OR=0.932,P=0.401),bullous pemphigoid(BP)(OR=1.191,P=0.642),vitiligo(OR=1.000,P=0.327),multiple sclerosis(MS)(OR=1.000,P=0.965),ankylosing spondylitis(AS)(OR=1.001,P=0.121),rheumatoid arthritis(RA)(OR=1.000,P=0.460).Additionally,no reverse causal relationship was found between autoimmune diseases and eczema.Conclusion:Eczema is associated with an increased risk of Crohn’s disease and ulcerative colitis.No causal relationship is found between eczema and SLE,MS,AS,RA,BP,or vitiligo.

Pathogenesis of Parkinson＇s disease： oxidative stress, environmental impact factors and inflammatory processes

Current hypothesis of neuronal degeneration in Parkinson＇s disease （PD） have been proposed, including formation of free radicals and oxidative stress, mitochondrial dysfunction, excitotoxicity, trophic factor deficiency, inflammatory processes, genetic factors, environmental impact factors, toxic action of nitric oxide, apoptosis, and so on. This review mainly discussed oxidative stress, environmental impact factors, and inflammatory processes in PD.

Control Efficacy and Antifungal Mechanism of Bacillus Cereus Strain JK14 against Wheat Take-all Disease

[Objective] Study on control efficacy and inhibitory effect of Bacillus cereus strain JK14^·against wheat take-all disease, investigating its antifungal mechanism. [Method] B. cereus JK14^· was isolated from soil in the rhizosphere of wheat, inhibitory effects of whose nutrient solution form against Gaeumannomyces graminis var tritici strains 9862 and 9812 were measured in laboratory and then for its antifungal mechanism. The strain JK14^· with rifampicin and wheat take-all disease resistance was screened by increasing concentration of the two substrates, and colonization of JK14^·was studied. [Result] In pot experiment, the control effects of JK14^·, against 9862 and 9812 are 63% and 59%, respectively, which are higher than that of chemical fungicides, with 55% and 51% , respectively. JK14^· could deform mycelium and causes degradation of cell wall. And there are also dynamic change of JK14^· in root system. JK14^· on seed could extend to root along with seed germination and rooting, but per unit tissue mycelium number decreased gradually. [Conclusion] The results indicate some control efficacy of B. cereus strain JK14^· against wheat take-all disease.

Immunologic pathogenesis of multiple sclerosis

Multiple sclerosis （MS） is an autoimmune disease. The etiology and pathogenesis of MS remain unclear. At present, there are substantial evidences to support the hypothesis that genetics plays a crucial role. The people who have genetic predisposing genes easily develop immune-mediated disorder, probably in conjunction with environmental factors. The aim of this review is to describe recent observations regarding the immunologic pathogenesis of MS.

月经过少的中医诊疗思路

目的:探讨月经过少的中医病因病机及治疗。方法:从中医理论认识出发,结合临床病史、症状、检查资料等,归纳致病因素及发病机理,确定治疗方案及方药。结果:常见病因为肾虚、血虚、气滞、血瘀、痰郁及手术等六类因素,而肾虚血瘀是月经过少的基本病机。治疗以补益肾精,化瘀调经为主,采用分期调周法,使肾-天癸-冲任-胞宫轴功能健全,肾精充足,经量恢复。结论:月经过少主要病因病机为肾虚血瘀,补肾养血、化瘀调经为主要治法,分期调周加减用药可提高疗效。

Relationship between Vascular Elasticity and Spontaneous Rupture of Hepatocellular Carcinoma

Objective Spontaneous rupture of hepatocellular carcinoma (HCC) is common in Asia and Africa with unclear mechanism. In our previous study, we found that the deposition of immune complex on vascular wall and vascular injury were related to the HCC rupture. In this study, the structure of elastin around the small artery was deeply investigated to confirm our previous study. Methods Immunohistochemical technique and transmission electron microscopy were used to study 23 specimens from ruptured HCC and 30 cases of nonruptured HCC. Results The layer of elastin around the vascular wall was significant thicker in patients with ruptured HCC than that in nonruptured HCC. The proliferation of elastin, abnormal distribution of neutrophil elastase and degradation of collagen fibril were predominantly present in the specimens from ruptured HCC. The phenomenon of electron—dense deposit in the elastic lamina that represented the deposition of immune complex, and the signs of infiltrated neutrophils from bloodstream into the vascular wall that caused the vascular injury, also can be found in ruptured HCC. Since the damaged vessels could become stiff and weak, which would more prone to be splitting and results in hemorrhage and the rupture of HCC, we postulated that the preexisting of immune complex deposition and vascular injury may be relate to the ruptured HCC. Conclusion The vascular injury caused by immune complex deposition might relate to ruptured HCC. Key words hepatocellular carcinoma - rupture - elastin - elastase

Hilar Cholangiocarcinoma with Synchronous Metastases to Breast and Skeletal Muscle: A Case Report and Literature Review

Hilar cholangiocarcinoma has been reputed as a slow growth tumor in the past. Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report herein a case of hilar cholangiocarcinoma with synchronous metastases to skeletal muscle and breast, and review the literature. The patient was a 48-year-old woman who presented with jaundice and weight loss. An inoperable hilar cholangiocarcinoma was diagnosed. She was treated with a combination of endoscopic plastic stent biloiary drainage and three-dimensional conformal radiotherapy （3DCRT）. Good response was achieved. Ten months later, she exhibited with a painful metastatic mass in the muscle rectus femoris of left thigh and a painless mass in the left breast. She underwent operation to relieve the pain, but died from liver failure after 8 months. The literature only offers isolated cases of cholangiocarcinoma with distant metastases, of which the common sites were cervical lymph node, bone, and portal venous system. Most patients were presented with multiple metastases with extensive local disease.

Juvenile Xanthogranuloma Presenting as a Solitary Tracheal Mass in a Child: A Case Report and Literature Review

Juvenile xanthogranuloma （JXG） is an uncommon benign disease, which usually occurs on the skin of head and neck region, as a single or multiple nodular lesions. Tracheal involvement of JXG is extremely rare, and only few cases have been reported in literature. Herein we presented an additional new case and discussed the optimal management of this uncommon disease.

Clinical Study of Photodynamic Therapy for Upper Gastrointestinal Tract Cancers

Objective： To evaluate the clinical effectiveness and adverse effects of photodynamic therapy （PDT） for the upper gastrointestinal tract cancers. Methods： 56 patients with upper gastrointestinal cancers in different clinical stages were treated with PDT. Diode laser （630 nm） was used as the light source and the parameters were as follows： power density 200 to 400 mW/cm, energy density 100 to 300 J/cm. PHOTOFRIN was used as photosensitizer, which was given in a dose of 2 mg/kg intravenously 12-24 h before irradiation. Results： Evaluation of the 56 patients＇ therapeutic effectiveness showed that 6 patients （10.7%） had a complete response （CR）, 33 patients （58.9%） partial response （PR）, 12 patients （21.4%） mild response （MR）, and 5 patients （8.9%） no response （NR）. The total response rate （CR＋PR） was 69.6%. No patients had severe adverse effects in this group. Conclusion： PDT is an effective and safe palliative modality for upper gastrointestinal tract cancers.

An Experimental Study of Pathogenesis of Steroid-induced Avascular Necrosis of Femoral Head

Objective: To explore the pathogenesis of avascular necrosis of femoral head(ANFH) and search an effective method for clinical practice. Methods: Twenty-four Japanese rabbitswere divided into 2 groups of models and controls. ANFH models were produced byintramuscular-injection of large dosage of steroid to rabbits for 8 weeks. From the 4th, 8th and12th week after production of models, 2 rabbits of each group were sacrificed to observe thestructure of femoral head through light microscope and scanning electron microscope. The contents ofNitric Oxide (NO), tissue-type plasminogen activator (t-PA) and -plasminogen activator inhibitor(PAI) in plasma of the 4 rabbits in each group were estimated at the same time. Results: Comparedwith control group, the rabbits of model group exhibited many differences: such as osteoporosis offemoral head, the presence of more bone lacuna and fat cell through light microscope observing; thebroken and sunk bone trabecula, the loosen and broken collagen fibers on the surface of bone matrixthrough scanning electron microscope observing. Compared with control group, the Concentration ofNO and t-PA in plasma of the model rabbits decreased obviously, but the Concentration of the PAIincreased obviously. Conclusion: The steroid-induced ANFH might be related to the lower level of NOand the descent of fibrinolytic activity.

In vitro Study of Interstitial Combination Chemotherapy in the Treatment of Glioma

Objective： To investigate the inhibitory effects of combination chemotherapy of Carboplatin （CBP）, Teniposide （Vm-26）, Methasquin （MTX）, and Nimodipine （NIM） on glioma, and to explore the sensitivity of glioma cells to different treatment regimens so as to provide some clues for clinical usage of interstitial combination chemotherapy. Methods： MTT assay and 3H-TdR incorporation assay were performed to evaluate the inhibitory effects upon the proliferation of glioma cells, and to compare the sen- sitivity of glioma cells to administration of CBP, Vm-26, MTX, and NIM with that of the administration of CBP＋NIM, Vm-26＋NIM, MTX＋NIM, CBP＋Vm-26＋MTX, or CBP＋Vm-26＋MTX＋NIM, respectively. Results： The inhibition rate of CBP＋Vm-26＋MTX＋NIM combination administration against glioma cells was 96.64%, higher than that of CBP＋NIM （69.03%）, Vm-26＋NIM （71.53%）, MTX＋NIM （52.75%）, CBP＋Vm-26＋MTX （78.59%） （P〈0.01）, and the dosage of CBP, Vm-26, and MTX was declined to 1/10- 1/100 that of respective use of CBP, Vm-26, and MTX. Conclusion： The curative effect of combination administration of CBP, Vm-26, MTX, and NIM was much better than that of respective administration, suggesting a higher inhibition rate and a lower dosage use.

Application of Self-propelled Boom Sprayers for Control of Rice Insects and Diseases

Comparisons were performed between self-propelled boom sprayer and traditional mechanis, such as knapsack sprayer and sprayer-duster, stretcher-type powered sprayer, as well as single rotor unmanned sprayer and multi-rotor un- manned sprayer. The effects on rice injury, lodging, and rehabilitation were conclud- ed and drug uniform distribution, sedimentation and prevention effects were ana- lyzed. The results showed that the self-propelled boom sprayer is characterized by high degree of automation, convenient operation, high adaptability, and high work efficiency. What＇s more, the sprayed fog quality is better, and fog distribution is more uniform. During the work process, fog loss would be diminished substantially, improving work efficiency and cutting down drug and water. It is notable that the underpart of the sprayer can be widely applied to plant protection in large-scale ar- eas in Jiangsu Province, significantly advancing whole-process mechanization of rice production.

The Characteristics of Immunophenotype in Acute Lymphoblastic Leukemia and Its Clinical Significance

Objective： To study the characteristics of immunophenotype in acute lymphoblastic leukemia （ALL） and its clinical significance. Methods： Immunophenotyping was performed on 81 ALL patients by three-color flow cytometry analysis using CD45/SSC gating, meanwhile the cytogenetic analysis was performed on 45 cases out of 81 ALL patients. Results： （1） CD19 was the most commonly expressed of all B-lineage antigens detected with the positive rate being 100%. In T-ALL, the positive expression rate of CD5 and CD7 was the highest, being 90%. Both B-ALL and T-ALL overlapped in expression of lineage antigens. There was no significant difference in the complete remission rate （CR rate） between T-ALL and B-ALL. （2） The incidence of ALL with rayeloid antigens expression （My＋ALL） was 39.5%. CD13 was most often seen among the myeloid markers. My＋ALL always involved in B-lineage antigens and the CR rate in children and adults was 72.2% and 78.6% respectively. （3） The incidence of HAL was 19.8%. Coexpression of B-lineage and myeloid-assoeiated antigens was the commonest subtype in HAL. The expression of CD34 was commonly seen in HAL patients （81.3%）. The CR rate was low in HAL, 50% for children and 40% for adults. （4） Compared to T-ALL, B-ALL, My＋ALL, and HAL had a higher positive rate of CD34 expression with the difference being significant （P〈0.025）. Conclusion： Immunophenotyping had remarkable predominance in diagnosing special category of ALL （such as HAL and My＋ALL）; CD19 and CD5 were highly sensitive in diagnosing B-ALL and T-ALL, but less special, and overlapping was found in expression. No significant association was found between the expression of CD34 or myeloid antigens and CR rate, while low CR rate was found in HAL patients, especially for those coexpressing CD34 antigen.

Therapeutic Effects of Stereotactic Radiotherapy on 389 Cases of Brain Glioma

Objective： To investigate the treatment effectiveness and side effects of stereotactic radiotherapy for brain glioma. Methods： From Jun. 1995 to Dec. 1998, 389 cases of brain gliomas were treated by stereotactic radiotherapy, among which 151 cases were treated by stereotactic radiosurgery （SRS） and the other 238 cases, by fractionated stereotactic radiotherapy （FSRT）. In the SRS group, the marginal tumor dose was 20 to 30 Gy （median, 2.6 Gy）. One to 6 isocenters （median, 2.48） and 5 to 21 irradiation arcs （median, 8.45） were applied. In the FSRT group, the per-fraction marginal tumor dose was 8 to 12 Gy with 1 to 6 isocenters （median, 2.53）, 6 to 20 irradiation arcs （median, 8.25） and 2-5 fractions delivered everyday or every other day. Results： Three months after treatment, the complete and partial response rates were 13.9% and 45.7% in SRS group respectively. The stable disease rate was 17.2%. The total effective rate was 76.8%. In FSRT group, the complete and partial remission rates were 19.7% and 47.9% respectively. The stable disease rate was 20.6%. The total effective rate was 88.2%. The total effective rate of FSRT group was higher than that in SRS group （X^2=9.874, P=0.020）. The 1-year, 3-year and 5-year survival rate of all patients was 54.3%, 29.3%, 16.5% respectively. The 1-year, 3-year and 5-year survival rate in SRS group and FSRT group was 52.3% vs 26.5%, 11.9% vs 55.5%, and 31.1 vs 19.3% respectively. There was no significant difference between the two groups （X^2=2.16, P=0.1417）. The brain edema caused by the main radiation was more severe in the SRS group than in FSRT group （X^2=4.916, P=0.027）. Conclusion： It is effective for brain glioma to be treated by stereotactic radiotherapy. Compared with SRS, the FSRT has the advantage of good effect and less side response.

Application of Support Vector Machine to Predict 5-year Survival Status of Patients with Nasopharyngeal Carcinoma after Treatment

Objective： Support Vector Machine （SVM） is a machine-learning method, based on the principle of structural risk minimization, which performs well when applied to data outside the training set. In this paper, SVM was applied to predict 5-year survival status of patients with nasopharyngeal carcinoma （NPC） after treatment, we expect to find a new way for prognosis studies in cancer so as to assist right clinical decision for individual patient. Methods： Two modelling methods were used in the study; SVM network and a standard parametric logistic regression were used to model 5-year survival status. And the two methods were compared on a prospective set of patients not used in model construction via receiver operating characteristic （ROC） curve analysis. Results： The SVM1, trained with the 25 original input variables without screening, yielded a ROC area of 0.868, at sensitivity to mortality of 79.2% and the specificity of 94.5%. Similarly, the SVM2, trained with 9 input variables which were obtained by optimal input variable selection from the 25 original variables by logistic regression screening, yielded a ROC area of 0.874, at a sensitivity to mortality of 79.2% and the specificity of 95.6%, while the logistic regression yielded a ROC area of 0.751 at a sensitivity to mortality of 66.7% and gave a specificity of 83.5%. Conclusion： SVM found a strong pattern in the database predictive of 5-year survival status. The logistic regression produces somewhat similar, but better, results. These results show that the SVM models have the potential to predict individual patient＇s 5-year survival status after treatment, and to assist the clinicians for making a good clinical decision.

Detection and Sequence Analysis of Escherichia coli Virulence Genes

[Objective] This study aimed to explore the pathogenic mechanism of E., cherichia coll. [Method] An E. coil strain isolated from raccoon dogs in vivo was studied, which had been identified, PCR was used to detect the gene of irp2 （301 bp） and fyuA （953 bp） related to E. coil virulence and PCR products were s, quenced. [Result] The genes of irp2 and fyuA were successfully amplified in boi strains isolated from raccoon dogs. Compared with the GenBank, the identity of tTr irp2 gene sequence and the fyuA gene sequence of the strain reached 98.5% 99.2% and 98.9%-100% respectively. Compared with each other, the identity of tt- two gene sequences of irp2 was 99.3%, and that between the two fyuA gene se quences was 98.9%. [Conclusion] This study provided scientific experimental data fi E. coil pathogenicity, prevention, diagnosis and treatment.

Patterns of Relapse and Management Options in Unknown Primary Cervical Metastatic Carcinoma

Objective: To analyze the patterns of relapse and management options in unknown primary cervical metastatic carcinoma (UPCMC) as well as to discuss its treatment strategies. Methods: Clinical data of 111 cases of eligible UPCMC were retrospectively studied. Neck control, primary relapse and long-term survival were compared among different groups. Results: Primary carcinomas ultimately appeared in 12 cases (10.8%, 12/111). Neck control rate was 36.9%. Overall 5-year survival rate was 41.4%. Neck control, N stage and primary control were prognostic factors for UPCMC. Neck control was affected by N stage and whether or not comprehensive radiotherapy was administered. Conclusion: UPCMC should primarily be treated by radiotherapy except for cases with N1 or N2 insensitive to radiation. Bilateral necks radiotherapy is the optimal choice in terms of neck radiotherapy. Selective total pharyngeal irradiation is recommended for potential primary treatment.

Replication-selective Oncolytic Adenovirus CNHK300 in the Treatment of Breast Cancer Cell Lines in vitro

Objective： To evaluate the tumor selectivity and therapeutic efficiency of replication-competent adenovirus CNHK300 on human breast cancer cells. Methods： RT-PCR was used to detect the hTERT mRNA activity in various breast cancer and normal fibroblast cell lines. Virus proliferation assay, cell viability assay and Western blot were applied to evaluate the proliferation and cytolysis selectivity of CNHK300. Results： The telomerase activity of MCF-7, BT-549 and SK-BR-3 was positive, while telomerase in MRC-5 and BJ was negative. The progeny virus titers in MCF-7, BT-549 and SK-BR-3 after 48 h of CNHK300 exposure was 40 625, 1 265 and 20 000 fold higher than those of 0 h, even slightly higher than those of wtAd5 （except in SK-BR-3）. ONYX-015 virus proliferation ability was weaker than that of CNHK300 in cancer cells. However, CNHK300 exhibited attenuated replicative ability as compared with wtAd5 in MRC-5 and BJ. The CNHK300 replicatative multiple was 63 and 192 fold at 48 h respectively, while the wtAd5 still multiplied 3 160-4 846 fold. CNHK300 could cause about half of breast cancer cells to die within 7 days at MOI 10 pfu/cell and below, whereas the IC50 in BJ and MRC-5 was as high as MOI 100 pfu/cell. CNHK300 E1A protein could be detected in breast cancer cells and 293 cells but not in normal fibroblast cells. Conclusion： hTERT promoter can successfully modulate the CNHK300 to be selectively replicated in breast cancer cells positive for telomerase, which may be a potential treatment strategy in breast cancer.

Treatment of Primary Liver Cancer with Postoperative After-Loading Radiotherapy and Gemcitabine

Objective： To evaluate the curative effectiveness of postoperative after-loading radiotherapy with the use of gemcitabine in 22 patients with primary liver cancer. Methods： From Oct. 1999 to Dec. 2001, 22 patients with primary liver cancer underwent postoperative after-loading radiotherapy 3-10 days after hepatectomy and chemotherapy using gemcitabine （1400 mg every week for 3 weeks, repeated after one week interval, total cycles were 6） and compared with 22 cases of sole hepatectomy. Three-six catheters were placed for irradiation after hepatectomy. The single-dose of after-loading radiotherapy was 10 Gy, 24 sessions per person. Results＇. The rate of AFP negative-reversion was 100% （17/17） in the treated group, higher than in control group （62.5%, 10/16, P〈0.05）. In the treated group, the 1-year relapse rate, metastasis rate and survival rate were 18.2% （4/22）, 0 and 100% （22/22） respectively, while in the control group they were 45.5% （10/22）, 13.6% （3/22） and 77.3% （17/22） respectively. There were significant differences between the two groups in relapse rate, metastasis rate and survival rate within a year （P〈0.05）. Conclusion： Postoperative after-loading radiotherapy with gemcitabine is an effective way for the treatment of primary liver cancer.