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As an important active ingredient in the rare Chinese herb Gastrodiae Rhizoma and also the main precursor for gastrodin biosynthesis, 4-hydroxybenzyl alcohol has multiple pharmacological activities such as anti-inflammation, anti-tumor, and anti-cerebral ischemia. The pharmaceutical products with 4-hydroxybenzyl alcohol as the main component have been increasingly favored. At present, 4-hydroxybenzyl alcohol is mainly obtained by natural extraction and chemical synthesis, both of which, however, exhibit some shortcomings that limit the long-term application of 4-hydroxybenzyl alcohol. The wild and cultivated Gastrodia elata resources are limited. The chemical synthesis requires many steps, long time, and harsh reaction conditions. Besides, the resulting by-products are massive and three reaction wastes are difficult to treat. Therefore, how to artificially prepare 4-hydroxybenzyl alcohol with high yield and purity has become an urgent problem facing the medical researchers. Guided by the theory of microbial metabolic engineering, this study employed the genetic engineering technologies to introduce three genes ThiH, pchF and pchC into Escherichia coli for synthesizing 4-hydroxybenzyl alcohol with L-tyrosine. And the fermentation conditions of engineering strain for producing 4-hydroxybenzyl alcohol in shake flask were also discussed. The experimental results showed that under the conditions of 0.5 mmol·L~(-1) IPTG, 15 ℃ induction temperature, and 40 ℃ transformation temperature, M9 Y medium containing 200 mg·L~(-1) L-tyrosine could be transformed into(69±5)mg·L~(-1) 4-hydroxybenzyl alcohol, which has laid a foundation for producing 4-hydroxybenzyl alcohol economically and efficiently by further expanding the fermentation scale in the future.
Subject(s)
Benzyl Alcohols , Escherichia coli/metabolism , Gastrodia/chemistry , Metabolic Engineering , Tyrosine/metabolismABSTRACT
OBJECTIVE@#To summarize the clinical outcomes of partial pubectomy assisted anastomotic urethroplasty for male patients with pelvic fracture urethral distraction defect (PFUDD) and discuss the skills of partial pubectomy.@*METHODS@#The clinical data of 63 male patients with PFUDD were retrospective reviewed. The procedure of the anastomotic urethroplasty was as follows: (1) circumferentially mobilizing the bulbar urethra; (2) separating the corporal bodies; (3) performing the urethral anastomosis after partial pubectomy and exposure of the healthy two ends of the urethra.@*RESULTS@#The mean age of the patients was (39.2±15.6) years (range: 15-72 years). The median time between incidents and operation was 15 months (range: 3-240 months) and the mean length of stricture was (3.85±0.91) cm (range: 1.5-5.5 cm). All the patients had undergone suprapubic cystostomy in acute setting. Thirteen patients (20.6%) were re-do cases and the patients who had undergone dilation, direct vision internal urethrotomy (DVIU), and open primary realignment were 22 (34.9%), 8 (12.7%), and 8 (12.7%), respectively. Assisted with partial pubectomy, the anastomotic urethroplasty had been successfully performed in all the patients. The mean time of operation was (160.2±28.1) min (110-210 min), and the mean evaluated blood loss was (261.1±130.3) mL (100-800 mL). There were 3 cases (4.8%) with perioperative blood transfusions. The postoperative complications were bleeding and urinary tract infection, which were controlled conservatively. The mean maximum urine flow rate was (23.7±7.4) mL/s (15.0-48.2 mL/s) after removing the catheters 4 weeks after urethroplasty. The median follow-up was 23 months (12-37 months). The urethroscopy showed 2 cases of stricture recurrences and 1 case of iatrogenic penile urethral stricture due the symptoms of urinary tract infection and decreased urine flow and all of them were successfully managed with dilation.@*CONCLUSION@#Partial pubectomy can effectively reduce the gap between the ends of the urethra and promote tension-free anastomosis during the anastomotic urethroplsty for patients with PFUDD. The skills of the procedure include good exposure of the anterior surface of pubic symphysis between the separated corporal bodies, carefully mobilizing and securing the deep dorsal vein of the penis, removing the partial pubic bone and the harden scar beneath the pubic bone for good exposure of the proximal urethral end.
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Adolescent , Adult , Aged , Humans , Male , Middle Aged , Young Adult , Anastomosis, Surgical , Pelvic Bones/surgery , Retrospective Studies , Treatment Outcome , Urethra/surgery , Urethral Stricture/surgery , Urologic Surgical Procedures, MaleABSTRACT
Aulus Cornelius Celsus (BC 25-AD 50), an ancient Roman Latin writer and compiler of encyclopedias, has been known as the “Cicero of medicine”. Celsus spread a lot of Greek scientific knowledge in beautiful Latin, published a treatise on medicine in a popular and concise way. Celsus published a book called De Medicina, which opened the history of modern pathology. This book had strong practicability and made a clear distinction between food therapy, drug therapy and surgery, which had a systematic influence on the development of western medicine. Celsus put forword primary prevention and held the view of that diet was the definitive treatment. He also discussed the empiricism and rationalism of medicine, which focused on individualized treatment to achieve the best results.
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Pierre Simon Laplace (1749-1827), known as "Newton of France", was the founder of analytical probability theory, invented Laplace’s law and integrated celestial mechanics. He promoted the development of analytical probability theory, led classical probability theory to follow the world trend, and also laid a solid foundation for the emergence of modern probability theory. He actively extended the application of probability theory to the fields of decision-making theory and maritime insurance. Laplace's law was not only applied in the field of physics, but also in the field of medicine, especially in cardiovascular, urology, anorectal and other disciplines, which is crucial for the interpretation of clinical symptoms and the selection of treatment methods. Laplace also used calculus to explore classical mechanics, successfully explained Newton's legacy of multi-planetary interaction.
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<p><b>Background</b>Robot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC.</p><p><b>Methods</b>From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient's characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed.</p><p><b>Results</b>LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients' characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups.</p><p><b>Conclusions</b>ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cystectomy , Methods , Laparoscopy , Methods , Retrospective Studies , Treatment Outcome , Urinary Bladder , General Surgery , Urinary Bladder Neoplasms , General Surgery , Urinary Diversion , MethodsABSTRACT
Objective To explore the characteristics and surgical managements of recurrent retinal detachment in silicone oil tamponade eyes.Methods The records of consecutive series of 134 patients (134 eyes) with recurrent retinal detachment in silicone oil tamponade eyes from January 2012 to December 2015 in our hospital were reviewed retrospectively,the vitrectomy combined with silicone oil replacement or scleral buckling procedure were performed.The follow-up time was 6 months,the surgical efficient was evaluated.Results 101 eyes underwent vitrectomy combined with silicone oil replacement.Retina was completely reattached in 79 eyes,and vitrectomy was reperformed in the left 22 eyes,the successful rate was 78.2％ (79/101);The visual acuity improved in 16 eyes,unchanged in 56 eyes,decreased in 29 eyes;The intraocular pressure of 31 eyes increased more than 25 mmHg (1 kPa =7.5 mmHg).33 eyes underwent scleral buckling procedure.Retina was completely reattached in 23 eyes,and vitrectomy combined with silicone oil replacement was performed in the left l0 eyes,the successful rate was 69.7％ (23/33);The visual acuity improved in 5 eyes,unchanged in 16 eyes,decreased in 12 eyes;The intraocular pressure of 14 eyes increased more than 25 mmHg.Conelusion For limited retinal detachment caused by inferior or peripheral holes,proliferative vitreoretinopathy in the A or B-class,the refractive medium does not affect the fundus examination,scleral buckling surgery is preferred;For the hole in the posterior pole or extensive retinal detachment caused by giant retinal holes,proliferation or retinal fixed fold formation,vitrectomy combined with silicone oil replacement is a better option.
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BACKGROUND: Screw fixation is mainly used in the treatment of femoral neck fractures in the youth; therefore, how to reduce surgical trauma, retain sufficient blood supply and reduce postoperative complications becomes so important. OBJECTIVE: To study the efficacy of minimal invasive percutaneous fixation with cannulated compression screws for young patients with femoral neck fracture and its impact on the length of bilateral lower limbs and hip joint function. METHODS: Thirty patients with femoral neck fracture admitted in the Shanghai Pudong Hospital Affiliated to Fudan University from January 2009 to December 2012, were selected as experimental group, followed by subjected to minimal invasive percutaneous traction bed-assisted closed reduction with cannulated compression screws. Meanwhile, 28 cases of femoral neck fracture admitted from January 2006 to December 2009, were given open reduction with square muscle grafting and cannulated screw fixation (control group). The efficacy, intraoperative blood loss, operation time, hospital stay, fracture healing time and incidence of complications were observed. Additionally, the length of bilateral lower limbs and Harris hip scores at 3 months and 1 year postoperatively were compared between two groups. RESULTS AND CONCLUSION: (1) All patients were followed up for 24-60 months. (2) The excellent and good rate in the experimental and control groups was 90% and 93%, respectively, which showed no significant difference between two groups (χ2=0.007, P > 0.05). (3) The intraoperative blood loss, operation time, and hospital stay in the experimental group were significantly less than those in the control group (P < 0.01); while, the fracture healing time, incidence of complications as well as length of bilateral lower limbs and Harris hip scores at 3 months and 1 year postoperatively did not differ significantly between two groups (P > 0.01). (4) These results suggest that the minimal invasive percutaneous fixation with cannulated compression screws applied in the treatment of young patients with femoral neck fracture exhibits satisfactory efficacy, good reduction, less trauma and rapid postoperative recovery, which is available for all types of young femoral neck fracture.
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BACKGROUND: Periprosthetic infection after total knee arthroplasty (TKA) has become the most serious complication. However, there is still a lack of clinical study on the distribution of pathogenic bacteria. Therefore, understanding the distribution characteristics of the main pathogenic bacteria is critical for preventing and treating OBJECTIVE: To analyze the bacteriological characteristics in the patients with periprosthetic joint infection following TKA, so as to provide reference for early prevention and treatment. METHODS: CNKI, VIP, WanFang and PubMed databases were retrieved for the literature concerning periprosthetic infection following TKA published before 2016. The incidence of periprosthetic joint infection after TKA was statistically analyzed. RESULTS AND CONCLUSION: (1) 103 articles were included, involving 1 399 patients. (2) The main pathogenic bacteria were Staphylococcus aureus,coagulase negative Staphylococcus aureus,Staphylococcus epidermidis,Escherichia coli, Streptococcus and Enterococcus.There is no significant difference in the distribution of bacteria at home and abroad. Treatment strategies are divided into conservative and surgical treatments. (3) The key for successfully preventing and treating periprosthetic infection after TKA lies in the multiple disciplinary team collaboration, understanding the distribution of bacteria, early diagnosis and active preventive measurements, as well as rational treatment strategies.
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Idiopathic macular hole (IMH) refers to full thickness defects of retina in macular area with no clear reasons.The management of IMH includes vitrectomy combined with internal limiting membrane (ILM) peeling and pharmacological vitreolysis.But ILM peeling may damage the inner retina;novel techniques,such as inverted ILM flap technique and foveola non-peeling ILM surgery,autologous ILM transplantation had made the method of ILM peeling more diversified with less damage.Pharmacological vitreolysis targeting fibronectin and laminin is considered to work in a two-step mechanism,involving both vitreoretinal separation and vitreous liquefaction.Furthermore,IMH judgment and prognosis indicators like ellipsoid zone,macular hole index,hole formation factor,diameter hole index and tractional hole index based on spectral domain optical coherence tomography enriched the assessment of macular hole diameter,depth and shape.How to make full use of new interventions to reduce the incidence of macular hole and obtain a better visual acuity with closed holes is an important direction for future research.
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Objective To study the function of X -1 2 -ARIMA model in analysis on incidence trend of typhoid. Methods Secular trend,seasonal periodicity and random fluctuations of the monthly morbidity data in Zhejiang province from 2005 to 201 3 were analyzed by X -1 2 -ARIMA model.Results The seasonal fluctuation showed a narrowing trend year by year during 2005 to 201 3.After September,2007,the incidence of typhoid showed a downward trend.After 2008,the annual peak of incidence changed from August to July.The irregular factor may well represent the outbreak. Conclusion The X -1 2 -ARIMA model showed clear secular trend and seasonal periodicity,and the random fluctuation was of great value.
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<p><b>OBJECTIVE</b>To explore the effects of bone mesenchymal stem cells (BMSCs) in restoring the functions of degenerative nucleus pulposus cells (dNPCs).</p><p><b>METHODS</b>The animal models of degenerative nucleus pulposus were established by means of acupuncture and aspiration. The BMSCs as well as the normal and degeneratived nucleus pulposus cells of SD rats were isolated and cultured. The BMSCs/alginate gel complex and dNPCs/alginate gel complex were used for indirect co-culture in vitro, which was set as experiment group. The NPCs and dNPCs cultured alone as positive and negative controls. The cell growth conditions were observed by light microscopy, and suitable cells were selected to combine alginate gel stents and cultured in transwell plate. Seven days later, nucleus pulposus cells of each group were recycled, and the mRNA expressions of Collagen2, SOX 9, and Aggrecan were detected by RT-PCR, and the Collagen1, 2, and Aggrecan were detected by Western blotting and immunofluorescence.</p><p><b>RESULTS</b>After non-contact co-culture for 7 days, the mRNA levels of Collagen2, SOX 9, and Aggrecan increased apparently in BMSCs+dNPCs group, while it was significantly lower in dNPCs sample (all P<0.05). The content of Collagen2 and Aggrecan detected by Western blotting in BMSCs+dNPCs group got close to NPCs sample, but it was significantly higher than dNPCs samples (all P<0.05), while the content of Collagen1in BMSCs+dNPCs group got close to NPCs samples, but it was significantly lower than dNPCs sample (P<0.05). Immunofluorescence results showed that cytoplasm was dyed red and the color near the caryon became dark in BMSCs+dNPCs group and dNPCs group;however, the colored scope of cytoplasm and the dark colored scope surrounding the caryon in BMSCs+dNPCs group was obviously larger than dNPCs group.</p><p><b>CONCLUSION</b>Under a 3D non-contact co-culture system, BMSCs can promote the expression of epimatrix of the dNPCs, which shows that BMSCs can restore the functions of dNPCs of intervertebral disc to certain extent.</p>
Subject(s)
Animals , Rats , Bone Marrow Cells , Physiology , Cells, Cultured , Coculture Techniques , Intervertebral Disc , Cell Biology , Pathology , Mesenchymal Stem Cells , Physiology , Rats, Sprague-DawleyABSTRACT
Objective To observe the expression of SGK in decidua in patients with unexplained recurrent spontaneous abortion(URSA) and to investigate its role in the course of apoptosis.Methods The expression of SGK was detected by immunohistochemistry in decidua of URSA(abortion group,n =50) and normal first trimester pregnant women(control group,n =30).The apoptotic index was detected by TUNEL.Results Compared with the control group,the positive expression of SGK decreased significantly in the abortion group,and the difference was statistically significant(x2 =6.78,P ＜ 0.05).The average apoptotic index of the abortion group was (8.19 ± 3.58) ％,which was significantly higher than (2.87 ±1.07)％ of the control group(t =7.94,P＜0.05).Conclusion Intensive apoptosis,the decreasing positive expression rate of SGK in decidua cells may play critical roles in URSA.
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<p><b>OBJECTIVE</b>To explore the effect of adenovirus-mediated human stromal cell-derived factor-1alpha (hSDF-1alpha) on ventricular remodeling in rats with myocardial infarction.</p><p><b>METHODS</b>A recombinant adenoviral plasmid containing hSDF-1alpha cDNA was constructed using homologous recombination in bacteria and the recombinant adenovirus particles expressing hSDF-1alpha (AdV-SDF-1) were prepared. In rat models of myocardial infarction induced by left anterior descending artery occlusion, 1x10(10) PFU AdV-SDF-1 or PFU AdV-LacZ were injected at multiple sites into the infarcted myocardium 1 h after the operation, using 200 l cell-free PBS as the control. Four weeks after the injection, the cardiac function of the rats was analyzed, and the heart tissues were taken after the measurement of hemodynamics. On serial frozen sections, histological observation and morphometric measurement were carried out using a microscopic image analysis system, and the expression of hSDF-1alpha was detected by immunocytochemistry.</p><p><b>RESULTS</b>Four weeks after AdV-SDF-1 injection, the myocardium in the infracted area showed significantly higher expression rates of hSDF-1alpha. The injection resulted in a obvious reduction in the infarct size and collagen content and a marked increase in the left ventricle wall, and the rats showed improved cardiac functions.</p><p><b>CONCLUSION</b>SDF-1alpha can improve the cardiac structure and function in rats with myocardial infarction by inhibiting collagen synthesis and deposition in the infarcted area.</p>
Subject(s)
Animals , Female , Male , Rats , Adenoviridae , Genetics , Metabolism , Chemokine CXCL12 , Genetics , Gene Transfer Techniques , Genetic Vectors , Genetics , Myocardial Infarction , Therapeutics , Rats, Sprague-Dawley , Recombinant Proteins , Genetics , Transfection , Ventricular RemodelingABSTRACT
<p><b>OBJECTIVE</b>To study the cause of weak expression of Ay antigens on the surface of erythrocytes and understand its molecular characteristics.</p><p><b>METHODS</b>Genotypic analysis of an individual of Ay serologic phenotype was performed using polymerase chain reaction with sequence specific primers (PCR-SSP). Sequence analysis of the 7 exons and some of the introns was carried out with ABI Prism 3100 DNA sequencer, and the Ay gene sequence was compared with A102 reference sequence.</p><p><b>RESULTS</b>The genotype of the Ay individual was A102/101. Sequence analysis identified a nt467C>T mutation, nt1009A/G heterozygosis and a nt517G-/C- deletion in the intron 5.</p><p><b>CONCLUSION</b>The molecular genetic background of the Ay phenotype is polymorphic. Our findings are not sufficient to explain the cause of weak expression of Ay antigens on the surface of erythrocytes in this individual.</p>
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Humans , Male , Antigens, Surface , Genetics , Base Sequence , Erythrocytes , Metabolism , Gene Expression Regulation , Genotype , Heterozygote , Introns , Genetics , Molecular Sequence Data , Mutation , Phenotype , Polymerase Chain Reaction , Sequence Analysis, DNA , Serologic TestsABSTRACT
<p><b>OBJECTIVE</b>Carnitine, the only carrier for fatty acid to enter mitochondria for oxidation, has significant effects on serum lipids metabolism and male fertility. This study aimed to investigate the correlation of serum carnitine levels with sex and age among healthy Chinese adults in Nanjing.</p><p><b>METHODS</b>We obtained fasting blood samples from 347 healthy Chinese adults in Nanjing (182 males, 165 females, aged from 20 to 89), determined the levels of serum free, acylcarnitine and total carnitine by high performance liquid chromatography with pre-column ultraviolet derivatization, and analyzed the correlation of serum carnitine levels with the age and sex of the subjects.</p><p><b>RESULTS</b>Total and free carnitine levels were significantly higher in the males than in the females (P < 0.05) while no statistically significant differences were found in the acylcarnitine level (P > 0.05). Among those aged between 20 to 50 years, levels of serum free and total carnitine were significantly higher in men than in women (P < 0.05) and they increased with age in females, but with no significant differences between males and females older than 50 years. The acylcarnitine level showed no obvious differences in any age and sex groups.</p><p><b>CONCLUSION</b>Serum free and total carnitine levels are correlated with sex and age in healthy adults.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Age Factors , Asian People , Carnitine , Blood , Chromatography, High Pressure Liquid , Sex FactorsABSTRACT
<p><b>OBJECTIVE</b>To genotype the RHCE gene of Hans, Xinjiang's Uigurs and Kazakstans in China, and to compare the results of RHCE genotyping with that of RhCc/Ee phenotyping.</p><p><b>METHODS</b>RHCE genes of 98 Hans with RhD positive and 230 Hans, 72 Uigurs and 18 Kazakstans with RhD/RHD negative were genotyped with PCR-sequence specific primer (SSP) technique.</p><p><b>RESULTS</b>The results of RHE/RHe genotyping from samples with RhD positive and negative were in accord with that of phenotyping. It would result in 4.44% error using C-->G polymorphism at nt48 of RHCE gene to genotype RHCE, and 4.05% failure of detection using the 109 bp insertion to detectRHCE gene in Chinese Hans. The results of RHE/RHe genotyping in unrelated 72 Uigurs and 18 Kazakstans with RhD phenotype were consistent with that of phenotyping, and false positive and false negative were not found in genotyping in Uigurs and Kazakstans tested.</p><p><b>CONCLUSION</b>The results of RHE/RHe and RHc genotyping were correct with PCR-SSP and accordant with that of phenotyping. Using the C48G polymorphism in exon 1 of RHCE to genotype RHC gene would result in false positive resulting from RHc mutation at this locus, and using the 109 bp insertion to genotype RHC gene would result in false negative because of the absence of the 109 bp. Therefore it is necessary to genotype RHC gene using more than two polymorphic loci.</p>
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Humans , Ethnicity , Genetics , Genotype , Phenotype , Polymorphism, Genetic , Rh-Hr Blood-Group System , Blood , Genetics , Serologic Tests , MethodsABSTRACT
Nucleoside phosphorylases (NPases) were found to be induced in Enterobacter aerogenes DGO-04, and cytidine and cytidine 5'-monophosphate (CMP) were the best inducers. Five mmol/L to fifteen mmol/L cytidine or CMP could distinctly increase the activities of purine nucleoside phosphorylase (PNPase), uridine phosphorylase (UPase) and thymidine phosphorylase (TPase) when they were added into medium from 0 to 8 h. In the process of enzymatic synthesis of adenine arabinoside from adenine and uracil arabinoside with wet cells of Enterobacter aerogenes DGO-04 induced by cytidine or CMP, the reaction time could be shortened from 36 to 6 h. After enzymatic reaction the activity of NPase in the cells induced remained higher than that in the cells uninduced.
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Cytidine , Pharmacology , Cytidine Monophosphate , Pharmacology , Enterobacter aerogenes , Enzyme Induction , Pentosyltransferases , VidarabineABSTRACT
Background mental imagery is a multi-componential process involving different mental operations. Objective The present study investigated the subsystems of visual mental imagery processing and their interactions. Methods: Four experimental tasks were done: (1) object, the ability to generate global mental images; (2) resolution, the ability to generate vivid,high-resolution mental images; (3) transformation,the ability to mentally rotate patterns in images, and (4) spatial imagery,spatial cognition. 91 university students (77 males, 14 females) participated in this study. Results: Object task was highly correlated with resolution task, and the same the tendency was found between transformation task and spatial task. Conclusion: The results indicate there are different subsystems of visual mental imagery and corresponding operative strategies, but with strong correlation among these processes and abilities.
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Background mental imagery is a multi-componential process involving different mental operations. Objective The present study investigated the subsystems of visual mental imagery processing and their interactions. Methods: Four experimental tasks were done: (1) object, the ability to generate global mental images; (2) resolution, the ability to generate vivid,high-resolution mental images; (3) transformation,the ability to mentally rotate patterns in images, and (4) spatial imagery,spatial cognition. 91 university students (77 males, 14 females) participated in this study. Results: Object task was highly correlated with resolution task, and the same the tendency was found between transformation task and spatial task. Conclusion: The results indicate there are different subsystems of visual mental imagery and corresponding operative strategies, but with strong correlation among these processes and abilities.
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<p><b>OBJECTIVE</b>To explore the prognosis factors of hilar cholangiocarcinoma, and investigate the relation between operative procedure and prognosis of it.</p><p><b>METHODS</b>A retrospective cohort study was investigated in 198 patients with hilar cholangiocarcinoma, who were treated in our hospital from December 1997 to December 2002. There were 117 males and 81 females. The age ranged from 27 to 81 years old with a mean of 56. Jaundice (94.5%), pruritus (56.6%) and abdominal pain (33.8%) were the main present symptoms. According to Bismuth-Corlette classification, there were 14 type I cases, 19 type II cases, 12 type IIIa cases, 15 type IIIb cases, 112 type IV cases and 26 unclassifiable cases. One hundred and forty four cases received open operative treatment, and the others only were treated with endoscopic approach (including ERBD or EMBE 21 cases, ENBD 31 cases) or percutaneous transhepatic cholangiodrainage (2 cases). Tumor resection was performed on 120 cases with a resection rate of 83.3%, included radical resection 59 cases (41.0%). Twenty-four cases underwent paunched biliary exploration and drainage.</p><p><b>RESULTS</b>The Cox's regression model analysis showed that occupation, preoperative maximum total serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival significantly, but gender, age, choledocholithiasis, hepatitis, preoperative serum CA19-9 level, Bismuth-Corlette type, histopathologic grading and postoperative chemotherapy were not significant prognostic factors. The postoperative survival of biliary drainage group, palliative resection group and radical resection group, which statistically differed pairwise. Between ERBD or EMBE group and palliative resection group, there was no statistical difference. So was between ERBD or EMBE group and biliary drainage group, or between ENBD group and biliary drainage group. The survival differed statistically between ERBD or EMBE group and ENBD group.</p><p><b>CONCLUSIONS</b>Operative procedure was the most important prognosic factor of hilar cholangiocarcinoma, radical resection still was the primary measure to cure and long term survival. For irresectable hilar cholangiocarcinoma, the effect of ERBD or EMBE could not be considered to be worse than that of open operative treatment.</p>