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During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
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Objective To construct a prognostic model of laryngeal cancer based on pyroptosis-related lncRNAs. Methods Transcriptome expression and clinical data of patients with laryngeal cancer were downloaded from TCGA database. Differentially-expressed pyroptosis-related lncRNAs were selected using Wilcox rank sum test and Spearman correlation analysis. LncRNAs associated with patients' prognosis were further selected using univariate Cox analysis (P < 0.05), and a prognostic model was established using multivariate Cox regression. ROC curve was used to assess the sensitivity and specificity of this model. Results There were a total of 483 differentially-expressed pyroptosis-related lncRNAs in laryngeal cancer tissues, compared with normal laryngeal tissues (|logFC|≥1, FDR < 0.05). Univariate Cox analysis showed that 23 differentially-expressed lncRNAs were associated with prognosis. Multivariate Cox regression analysis finally obtained a prognostic model based on 10 lncRNAs for predicting the survival of laryngeal carcinoma patients. AUC showed that the model had a good predictive ability (AUC > 0.8). Conclusion Pyroptosis-related lncRNAs can be used to predict the prognosis of patients with laryngeal cancer.
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Objective To summarize the brain protection application experiences of combined internal and external blood shunt technologies for the in-situ three-fenestration revascularization of aortic arch.Methods From Feb 2017 to Jun 2018,8 patients with aortic arch leisons were treated by the in-situ three-fenestration techniques,including 3 aortic dissection,2 aortic aneurysm,3 postoperative TEVAR patients.We adopt the method of internal and external blood shunt technologies for brain protection using the vascular sheath for fenestration combined with carotid shunt tube skills,and using TCD to monitor the blood flow of brain.Results All operations completed successfully,and TCD showed no significant cerebral ischemia when aortic stent was used to cover the three branches of the aorta.The mean time of brain protection was (17.62 ± 6.87) minutes.One patient developed transient cerebral ischemia after surgery,and another one developed cerebral infarction.Conclusions The brain protection strategy of internal bypass combined with external converter technology maintain the brain blood flow,while is simple and feasible,it cannot completely avoid neurological complications.
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Objective To evaluate the safety and efficacy of fenestrated endovascular aortic repair (fEVAR) using physician-modified stent grafts(PMSGs) to repair aortic dissection aneurysm.Methods Nine consecutive patients who underwent fEVAR using PMSGs from Jan 2018 to Jun 2018 were retrospectively reviewed.Results Nine PMSGs (6 Ankura stent grafts,3 COOK Zenith stent grafts) were deployed.Initial technical success rate was 97.0％ (32 of 33).Mean operative time was (303 ± 51) min.There were no in-hospital death and no perioperative neurology complications.All the patients survived at a median follow-up of 6.1 mouths (ranging 3-10 months).During follow up,no postoperative complications occurred,all target vessels remained patent and no fenestration-related type Ⅰ endoleak were observed.There are 3 cases of type Ⅱ and 2 cases of type Ⅲ endoleaks respectively.Conclusions FEVAR using PMSGs may be a viable alternative for patients with post aortic dissection aneurysm.
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Objective To summarize the experience and effect of applying 3D printing to repair thoraco-abdominal aortic disease with fenestrated stent-graft or branch stent-graft technique.Methods From Oct 2017 to Sep 2018,22 patients with thoracic and abdominal aortic diseases,including aortic arterial dissection (9 patients) and aortic aneurysm (13 patients) were admitted.There were 19 males and 3 females,with mean age of (60 ± 13) years.Before the surgery 3D printing model guide plate was made according to CT,and then the pre-fenestrated stent-graft technique,branch stent-graft technique and other techniques were adopted in the surgery to perform endovascular repair.Resuits All of the operations were completed in one stage without open surgery.The average operation time was (5.67 ± l.23) hours without renal insufficiency and paraplegia,1 branch artery was lost during operation (1.4％) and 1 patient died (4.5％).Conclusion The application of 3D printing in the treatment of thoraco-abdominal aortic disease involving branches is more accurate than traditional measurement and localization.It had a safe and reliable short-term result.
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Objective To evaluate the feasibility and safety of endovascular intervention for the treatment of filter-related long segment obstruction of IVC and iliac vein.Methods From January 2014 to October 2016,a total of 8 patients with filter-related chronic long segment obstruction of IVC and iliac vein were treated with percutaneous transcatheter angioplasty (PTA) and stent implantation.The clinical data and imaging materials were collected.The endovascular interventional treatment methods were discussed,and the technical success rate,procedure-related complications and follow-up results were analyzed.Results Successful recanalization of the obstructed IVC-iliac vein segment was achieved in all 8 patients.In 7 patients,angiography performed immediately after PTA and stent implantation showed that the blood flow in the stent was smooth and the collateral vessels were decreased.In one patient,acute in-stent thrombosis occurred after PTA and stent implantation,then catheter-directed thrombolysis had to be adopted,and angiography performed 2 days later indicated that in-stent thrombosis was completely dissolved and the blood flow resumed smoothly.The patients were followed up for 2-13 months,with a mean of (4.7±3.9) months.Reexamination with both CT and venography of lower limb showed that the stent was kept in good position to the last visit in all 8 patients.Slight intimal hyperplasia was observed in 3 patients,but the blood flow was unobstructed.Conclusion Long term implantation of filter may cause filter-related chronic long segment obstruction of IVC and iliac vein.PTA with stent implantation is a safe and feasible method to effectively open the occluded vessels.
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Objective To assess the feasibility and efficiency of pedal-plantar loop technique in the treatment of below-the-ankle arterial occlusion . Methods A retrospective analysis was undertaken on 12 cases ( 14 legs ) of below-the-ankle arterial occlusion.The pedal-plantar loop angioplasty was performed in all the cases .Balloon angioplasty was performed after traversing through the arterial obstruction sites using antegrade or retrograde technique .After 6 months of the surgery , the results of visual analogue scale , dorsal or plantar arterial pulse volume scores , ankle brachial index , TcPO2 , and healing of the ulcer were compared to preoperative measures. Results Technical success was achieved in 9 cases (11 legs).During follow-up, 1 patient died of cerebrovascular events 2 months after the therapy .The other 8 cases (10 legs) were followed up for 6 months and no one had recurrent ischemic symptoms . The results of visual analogue scale , ankle brachial index, and TcPO2 before the surgery were (5.68 ±1.09) points, 0.60 ±0.04, and (25.71 ±5.25) mm Hg, which were improved to (0.44 ±0.27) points, 0.87 ±0.05, and (35.90 ±5.28) mm Hg (P<0.05).Dorsal or plantar arterial pulse volume scores were also enhanced markedly (P=0.004).Complete ulcer healing was observed in 8 limbs.No related complication was observed in other patients after the surgery .One technical unsuccessful patient who suffered infection and severe rest pain was given leg amputation . Conclusion Pedal-plantar loop technique is an effective therapy for below-the-ankle arterial occlusion while long term follow-up data need to be collected .
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BACKGROUND:Suitable stress signals such as extracorporeal shock wave (ESW) and parathyroid hormone can be involved in regulation of bone formation and metabolism. OBJECTIVE:To investigate the effects of low-density ESW and low-dose intermittent recombinant human parathyroid hormone 1-34 (rhPTH1-34) on the proliferation and differentiation of osteoblasts from rats cultured in vitro. METHODS:Osteoblasts from the skul of neonatal rats were cultured using col agenase digestion method. After 60-150 times of stimulations of 0.18 mJ/mm2 ESW, different patterns of rhPTH1-34 at 10-12-10-10 mol/L and ESW+intermittent rhPTH1-34 (10-11 mol/L), osteoblasts were col ected to observe cel proliferation by cel counting, MTT and flow cytometry analysis and to observe cel differentiation by measuring alkaline phosphatase and type I col agen expression. RESULTS AND CONCLUSION:0.18 mJ/mm 2 ESW (60-150 times), intermittent rhPTH1-34 (10-11 and 10-10 mol/L) and ESW+intermittent rhPTH1-34 (10-11 mol/L) stimulations could al improve proliferation and differentiation of rat osteoblasts cultured in vitro (P<0.05). ESW (60-150 times)+intermittent rhPTH1-34 stimulation showed better effects than ESW and intermittent rhPTH1-34 alone (P<0.05). These findings indicate that the combination of suitable ESW stimulation and low-dose intermittent rhPTH1-34 stimulation can improve the proliferation and differentiation of rat osteoblasts significantly.
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BACKGROUND:Endothelial progenitor cel s, known as the precursor cel s of mature endothelial cel s, have the function of neovascularization and neoendothelialization. Therefore, endothelial progenitor cel s have potential applicability in many fields. Endothelial progenitor cel s can be isolated and cultured from different resources with different methods, but the biological properties and identification of endothelial progenitor cel s stil have controversies. OBJECTIVE:To explore the methods of isolation and culture of endothelial progenitor cel s from the human peripheral blood and to identify the biological features of endothelial progenitor cel s. METHODS:Mononuclear cel s were isolated from the human peripheral blood using density gradient centrifugation, and the cel s were resuspended in endothelial basal medium-2 supplemented with the EGM-2-MV-SingleQuots. Then, the cel s were inoculated in human fibronectin-coated culture flasks and cultured in EBM-2MV medium. The morphology of endothelial progenitor cel s was observed. The proliferation potential and surface markers of endothelial progenitor cel s were characterized careful y. Furthermore, the functional properties such as nitric oxide release and tube formation on Matrigel were also evaluated. RESULTS AND CONCLUSION:While adherent cel s maintained, spindle-shaped cel s formed a cel cluster after 6-7 days. Then, adherent cel s developed to endothelial progenitor cel s with a cobblestone appearance after 2-3 weeks. The endothelial progenitor cel s were confluent with an outgrowth appearance. Endothelial progenitor cel s had a higher proliferation potential compared with human aortic endothelial cel s under the same culture condition. Endothelial progenitor cel s expressed CD31, CD34, CD144 and KDR, displaying an obvious endothelial phenotype. Endothelial progenitor cel s were also found to uptake DiL-acLDL and exhibit lectin binding capability. Furthermore, endothelial progenitor cel s were able to form capil ary tubes on Matrigel and had the ability to release nitric oxide. Therefore, endothelial progenitor cel s can be obtained from the human peripheral blood by density gradient centrifugation and adherent culture. A combining method for the identification of endothelial progenitor cel s should be recommended.
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Objective To discuss the experience in the diagnosis, treatment, complications and follow up of carotid body tumor. Methods All the 25 cases were diagnosised by DSA and CTA. The tumor was resected under carotid adventitial plane in 18 cases, with external carotid artery resection in 4cases, and in 3 cases, internal carotid artery (ICA) and external carotid artery (ECA) were resected simultaneously in which internal carotid artery was reconstructed in two cases including using self vein bypass in one and anastomosis between ICA and ECA in the other. ICA was ligated in the third case. Results No cases died perioperatively. ALL CBTs were treated successfully. Horner syndrome and trachyphonia were relieved after operation. Postoperative trachyphonia, bucking and lingual paralysis developed in 3 cases, and in one case with vagus resection caused dyspnea tracheotomy was performed. The rate of nerves injuries was 12% but no semiplegia and aphasia occurred. Follow up period was from 4 to 90 months (average 44 ±6 months) for 21 cases. The trachyphonia and bucking were improved during follow up but the lingual paralysis persists, and tumor recurred in two cases with one dying. Conclusions CBT treatment should include active surgery, sufficient preoperative preparation and avoiding the postoperative nervous complications.
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Objective To investigate the effects of total hip replacement (THR) and dynamic hip screw (DHS) to intertrochanteric fracture in the geriatric with serious osteoporosis. Methods The clinical data of 51 senile cases (age over 60 years) with serious osteoporosis (Singh index less than grade Ⅲ ) cured from January 2003 to March 2008 were retrospectively reviewed. Two different groups were randomly selected from all cases treated with THR and DHS. Nineteen cases of THR were selected in THR group, modified Gibson approach was taken to complete hip joint replacement Thirty-two cases of DHS were selected in DHS group,lateral hip approach was employed to complete DHS fixation. Mobilization by CPM from the 2nd day and weight burdening from 3rd to 7th day according to general physical condition after surgery were carried out in THR group, mobilization and weight bearing start according to different conditions from the 2nd to 10th week in DHS group. Results Among 51 cases, 47 cases had got follow-up for 5.0 -40.5 (28.1 ± 11.9) months. Nineteen cases in THR group had got follow-up, Harris hip score of 18 cases (94.7% ) were good or excellent, and the other 1 case was bad. Twenty-eight cases in DHS group had got follow-up. Harris hip score of 23 cases (82.1% ) were good or excellent, and the other 5 cases were bad. There was statistical significance between the two groups (P < 0.05 ) . The average periods to start partly weight bearing of THR group and DHS group were( 8.3 ±4.2) days and (43.6 ± 15.3) days respectively, there was statistical significance between the two groups (P< 0.05). Conclusion To the geriatric intertrochanteric fracture with serious osteoporosis, THR is a better choice than DHS, because THR has shorter recovery period before full weight bearing, higher hip functional outcome evaluated by Harris hip score, earlier recovery of mobilization and less complications related with long term bed-bound .
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Objective To investigate the technical details and therapeutic effect in treating StarIdford B aortic dissection by endovaseular aortic repair(EVAR). Methods We retrospectively review 115 type B aortic dissection cases undergoing the procedure of mini-traumatic EVAR from November 1998 to February 2009.There were 71 male patients and 44 female patients with a mean age of55.7 years and follow up period from 7 to 83 months for 75 cases. Results The procedure Was technically successful in 113 cases and 122 stent grafts were placed with hybrid surgery being carried out in 3 cases of carotid artery bypass.Severe perioperative complications included subclavian steal syndrome in 4 eases,pulmonaryinfections in 3 cases.arterial embolism in 2 cases,acute cerebral infarction in 2 cases,kidney tailure in 2 cases.alimentary tract hemorrhage,graft infection,acute intestinal ischemia and type A dissection occurred in one each case respectively.Five cases died perioperatively.Among the 75 cases that were fouowed up,there were 9 eases with type I endoleak and at last 5 cases redid endovaacular repmr.2 cases with secondary type A dissection accepted graft replacement.There were 6 deaths during the follow-up period,4 dying of acute myocardial infarction(2 cases),cerebral hemorrhage(1 case),type A dlssection (1 case)respectively,the causes of other2 deaths were not confirmed. Conclusion EVAR was effective for Standford B aortic dissection as shown by midterm follow up.
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Vascular prosthesis can absorb y-globulin or fibrinogen when they are transplanted in vivo, accordingly the cellular components in blood, such as platelet, are easy to attach on surface and become fiat shape to be activated, which then result in an inreversible aggregation and thrombus formation. During the process of transplanting vascular prosthesis at a diameter of more than 6 mm, a high vascular patency rate can be observed, while small-diameter (< 6 mm) vascular prosthesis transplantation is under low blood flow, therefore it produces the thrombosis. It is necessary to conduct surface modification of small-diameter vascular prosthesis and to enhance hemocompatibility. The main methods of modification include the alter of surface structure of vascular prosthesis, the augmentation of endothelial cells attachment on surface of vascular prosthesis, and grafting modification of vascular prosthesis surface.
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BACKGROUND: At present, the commercial artificial small vascular grafts (diameter < 6 mm) are still unsatisfactory, due to poor blocompatibility and low long-term patency rate. Therefore, finding a vascular substitute with normal biological function and studying construction and function of tissue-engineered blood vessel have become hot topics recently.OBJECTIVE: To construct a novel tissue-engineered blood vessel by rabbit bone marrow mesenchymal stem cells (MSCs) and vascular acellular matrix, and to investigate the biocompatibility and patency rate of tissue-engineered blood vessels.DESIGN, TIME AND SETTING: An in vitro randomized controlled study at level of cytology and histopathology was performed at the Laboratory of Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2006 to June 2008.MATERIALS: The decellularized vascular acellular matrix was obtained by a detergent-enzymatic procedure. MSCs from rabbits were isolated using density gradient centrifugation method and cultured in culture flasks coated with fibronectin. Subsequently, the expanded MSCs were seeded on the decellularized scaffolds, and then co-cultured in the self-made bioreactor to construct the tissue-engineered blood vessels.METHODS: Sixty rabbits were randomly divided into three groups. A1.0-cm abdominal aorta was sheared, and a tissue-engineered blood vessel was transplanted on the abdominal aorta using 8/0 polypropylene thread. Tissue-engineered blood vessel group: Tissue-engineered blood vessel was considered as the transplanted vessel; vascular acellular matrix group:Xenoma artery treated by vascular acellular matrix was considered as the transplanted vessel; xenoma artery group: Fresh xenoma artery was considered as the transplanted vessel.MAIN OUTCOME MEASURES: Immunocytochemical staining was used to identify the cultured MSCs. After 3 months of transplantation, the grafts were retrieved for digital subtraction angiography, pathological test and scanning electron microscope examination.RESULTS: Rabbits MSCs presented a whirlpool-like appearance at 8 days after culture. The immunocytochemistry results were consistent with the phenotype of MSCs. After high proliferation, MSCs were seeded onto the vascular acellular matrix for 12 days,and seed cells attached to well in the lumen of blood vessels. Three months after implantation, the patency rate was 90% of tissue-engineered blood vessel group and 80% of vascular acellular matrix group, which was superior to xenoma artery group (25%). At three months after transplantation, HE staining and scanning electron microscope demonstrated that internal, middle,and external membrane were clearly observed in the tissue-engineered blood vessel group, and the membrane morphology was similar to normal artery. The endothelial cells were covered completely. However, the endothelial cells were not covered completely in the vascular acellular matrix group, while mural thrombosis, mild proliferation of intima, and inflammatory cell infiltration were observed. The intima was thick and necrotic in the xenoma artery group, while lumens were stenotic and accompanied with a certain degree of thrombus organization.CONCLUSION: This study provides a new strategy to develop a tissue-engineered blood vessel with excellent biocompatibility and high patency rate constructed by rabbit MSCs and vascular acellular matrix.
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Objective To observe the effect of treating pediatric blood-stasis pattern bronchitis with pollen formula.Methods 260 cases of blood-stasis pattern bronchitis was randomly recruited into a treatment group(200 eases)and a control group(60 cases).The treatment group was treated with pollen formula,and the control group was treated with Benzylpenicillin intramuscularly and Ketelin OP.Both groups were treated for a therapeutic coarse of 3 days.Results The therapeutic effect of the treatment group and the control group was 96%and 89.9%respectively.Conclusion Pollen formula was effective in treating pediatric blood-stasis pattern bronchitis.
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Objective To investigate the reveral effect of Tanshitone(Tan) Microemulsion on multidrug resistance(MDR) of sensitive K562 cell line(KS) and ADM resistant K562 cell line(KA) and the mechanism.Methods The reversal effect of Tan Microemulsion(Tan and Microemulsion as controls) on MDR of KA cells was observed.The inhibitory effect of cell growth was investigated by MTT.The apoptosis of KS and KA cell lines was observed by flow cytometry.The intracellular drug concentration was measured by detecting fluorescent density.Results The result showed that Tan Microemulsion,Microemulsion and Tan reduced the expression levels of P-gp and Bcl-2 in KA cells and Tan Microemulsion had the most significant effect.The MDR reversal folds of Tan Microemulsion of KA was highest among all 3 groups(P
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OBJECTIVE To explore the expression pattern of AQP1,AQP4,AQP5 in the normal middle ear in guinea pigs and its roles in the water homeostasis in the middle ear cavity.METHODS Reverse transcription polymerase chain reaction(RT- PCR),Western blotting and immunohistochemical staining were used to detect AQP1,AQP4,AQP5 in mucosa of the bullae of normal guinea pigs.RESULTS Reverse transcription-polymerase chain reaction and immunoblot analyses revealed that mRNAs encoding AQP1,AQP4,AQP5 were expressed in middle ear membrane of the guinea pigs.AQP1,AQP4 was also detected as 28-kDa,33-kDa proteins in middle ear cavity of guinea pig.Immunohistochemical staining showed that only AQP1 located at capillary endothelial cells and fibroblasts of the submucous layer,as well as at flat and cubical epithelial cells.CONCLUSION The results suggest that AQP1,AQP4,AQP5 can express in the normal middle ear cavity of guinea pigs and may play a vital role in the water transmission in the middle ear.The air-filled middle ear cavity may result from the working of AQP1,AQP4,AQP5.
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BACKGROUND: Multidrug resistance (MDR) makes the treatment of tumor more difficult. Many factors contribute to the happening of MDR. The combination of two or more kinds of reverse reagent at the same time may be more effective to MDR.OBJECTIVE: To investigate the reversal effect of Tanshinone Microemulsion on MDR of human leukemia cell line (K562) and ADM resistant cell line (K562/ADM) cell line and the mechanism of it.DESIGN: An observational controlled experiment.SETTING: First Affiliated Hospital's Central Laboratory of Jilin University.MATERIALS: K562 and K562/ADM (Tianjin Blood Research Institute of CAS). Tanshinone and Tanshinone Microemulsion (Pharmaceutical College of Jilin University). ADM(Pfizer pharmaceutical corp). P-gp-PE fluorescent antibody and Bcl-2-FITC fluorescent antibody (Immunotech Biotech corp).DMSO(Beijing Chemical Plant).METHODS: The experiment was carried out in the Central Laboratory of First Hospital ffiliated to Jilin University from March 2003 to January 2004. ① K562 was cultured in liquid medium(RMPI1640) which contains 100 g/L calf serum, 100 U/mL penicillin and streptomycin. The culture tank's environment was kept at 37 ℃, with saturated humidity and 5%CO2. K562/ADM was cultured in the same environment as above, but ADM was added to the RMPI1640. ② The reverse effect of Tanshinone Microemulsion (Tanshinone and Microemulsion as control) on K562/ADM cells' MDR is observed. ③Tanshinone Microemulsion,Tanshinone and Microemulsion's MDR reverse fold to K562 cell line was detected by the method of MTT. ④ ADM of different concentrations (10, 20, 40, 60 mg/L)were added to grouped cells of exponential proliferation period. The intracellular drug concentration was observed by detecting fluorescent density.⑤ Expression rate of P-gp, Bcl-2 and apoptosis ratio of K562 and K562/ADM added with Tanshinone Microemulsion, Tanshinone and Microemulsion cell line were observed by the method of Flow Cytometry.MAIN OUTCOME MEASURES: ①Tanshinone Microemulsion, Tanshinone and Microemulsion's MDR reverse fold to K562 cell line. ②Tanshinone Microemulsion, Tanshinone and Microemulsion's effect to K562 cell's intracellular contration.③Tanshinone Microemulsion, Tanshinone and Microemulsion's influence to K562 cell's expression rate of P-gp, Bcl-2 and apoptosis ratio.RESULTS: ①Tanshinone Microemulsion, Tanshinone and Microemulsion could decrease the MDR of the K562/ADM. The effect of Tanshinone Microemulsion were significantly higher than Tanshinone and Microemulsion(P ＜ 0.05 ).②The intracellular concentration of ADM can be improved by Tanshinone Microemulsion, Microemulsion and Tanshinone. The ADM's concentration of K562/ADM treated by Tanshinone Microemulsion is highest and the difference is significant(P＜ 0.05). ③Tanshinone Microemulsion, Tanshinone and Microemulsion could reduce the expression level of P-gp and Bcl-2 in K562/ADM, and increase the apoptosis percentage of tumor cell. Tanshinone Microemulsion has the most significant effect on it,andincreases the apoptosis percentage of tumor cell with ADM (P ＜ 0.05 ).CONCLUSION: Tanshinone Microemulsion (0.5 mg/L) can increase the intracellular concentration of ADM, which is consist with the conclusion of down regulation of the expressions of P-gp and Bcl-2. Reversal effect of Tanshinone Microemulsion is more effective than that of Tanshinone and Microemulsion.