Objective To analyze the clinical features, recurrent characters in patients with recurrent Tolosa-Hunt syndrome (THS). Methods The clinical data of 24 hospitalized patients with recurrent THS from January 2006 to May 2016 were collected The general features, clinical manifestations, disease courses, recurrent features, lab and imaging studies, treatment measures and outcoming of recurrent THS patients was investigated , and compared with 69 patients with first attack THS in corresponding period. Results Recurrent THS patients were 25.8%(24/93) of total THS. The male rate in recurrent group was significantly higher than that in first attack group: 66.7%(16/24) vs. 42.0%(29/69), P<0.05. The involved rate of trigeminal nerves in recurrent group was significantly lower than that in first attack group:16.7%(4/24) vs. 33.0%(23/69), P<0.05. The disease courses were from 3 months to 20 years. The total recurrent frequencies were from 2 to 10 times. The recurrence occurred in the same side in 18 patients, and in contralateral in other 6 patients. The intervals were from 3 months to 6 years, and average intervals were 1.9 years. Two patients recurred in hormone reduction, and 22 patients recurred in hormone withdrawal. All cases received MRI examination. Nineteen patients (79.2%) of them had lesions in cavernous sinus. 16 patients had one side lesions and 3 patients had bilateral lesions. The recurrent patients still had good responds to corticosteroids treatment. Conclusions Recurrences in THS are common, taking place in about 26%total patients, and usually at an interval of months or years from the initial attack. These recurrences may be ipsilateral, contralateral, or rarely, bilateral. Corticosteroids are still effective to recurrent cases.

The integration of the biochemistry teaching content in thematic teaching pattern is the key link to realize the specialization of biochemistry and the theme of teaching contents.Around the theme of the content integration,weakening discipline consciousness and serving the professional ability are the requirements of curriculum reform of the new era and the requirements of the education concept students as the main body,teachers as the leading.In practice,we should conduct content integration three-dimensional perspective fromthree-dimensional perspective three dimensional perspectives of biochemicalthreedimensional perspective knowledge,professional and practical characteristics,including the integration of professional theme and the integration of teaching theme in order to build a suitable subject teaching mode,to further improve the teaching effect of biochemistry.

Objective To investigate the clinical and image features of cerebral venous sinus thrombosis (CVST) presented as isolated intracranial hypertension.Methods The medical records of patients with diagnosis of CVST presented as isolated intracranial hypertension were reviewed.Clinical features and imaging data were retrospectively analyzed.Results Twenty cases of CVST were included,all these patients were clinically presented as isolated intracranial hypertension.The male to female ratio was 13:7,and the average age was (38.3 ± 11.7) years old.None of the patients was obesity.The visual acuity was lower than 0.1 in 42.5％ (17/40)of the eyes.Possible risk factors relevant to CVST were found in 11 cases (55％),including head trauma for 4 cases,autoimmune disease for 2 cases,and other causes of single case including spontaneous abortion,phlebitis,otitis media postoperative,trigeminal nerve microvascular decompression surgery and obstructive sleep apnea syndrome.Image analysis showed that lateral sinus thrombosis was involved in 85％ (17/20) of the patients,while superior sagittal sinus was involved in 35％ (7/20),and 65％ (13/20) of the patients were isolated lateral sinus thrombosis.Conclusions Young male predominance is found in CVST patients which presented as isolated intracranial hypertension but severe visual function loss.Risk factors such as head trauma are commonly found in these patients.Most of the patients are isolated lateral sinus thrombosis,with lateral sinus narrowing as the most common abnormal findings in magnetic resonance venogram.

Objective To explore the effect of a new prone position for general anesthesia.Methods 50 patients in the group were made a retrospective study:All the 50 patients needed prone position surgeries under general anesthesia.After awake flexible fiberoptic intubation,with the anesthesia of thyrocricoid puncturing the intra-trachea surface,has been taken,patients lied in the prone position according to their own comfort with the guide of medical staff,which was followed by anesthesia induction and the operation.The SBP,DBP,HR and RPP were recor-ded at different point of time after patients entered the operation room.Results 33 cases of 50 patients completed the whole process successfully and the indexes at the time of the intubation had no significant difference with those at basic state(all P >0.05).17 operations suffered discomfort.The SBP,DBP,HR and RPP in these patients were (159.2 ±25.9)mmHg,(97.2 ±11.6)mmHg,(98.2 ±9)beats per minute and (16 028 ±6 725)respectively, which were higher than those at basic state(t =2.698,2.802,5.720,8.905,all P <0.05).After applications of small dose sedative,these patients were successfully tracheal intubated.The SBP,DBP,HR and RPP were (144.0 ± 18.5)mmHg,(83.0 ±10.5)mmHg,(89.3 ±10.0)beats per minute and (12 658 ±5 521)respectively at the time of the second intubation,which had no significant difference with those at basic state(all P >0.05).Conclusion It is technically simple and easy to operate,the way that patients waiting for prone position surgeries lie in the prone position by themselves with awake flexible fiberoptic intubation lightens the workload of medical staff and reduces complications of the intubation,which is optional in clinical situations.

Objective To investigate the role of a transcription factor p 53 in dengue virus infec-tion.Methods A plasmid expressing siRNA specific for p 53 gene was constructed and then used to prepare HepG2 cell line with a suppressed expression of p 53 protein.The expression of p53 protein was detected by Western blot assay .A wild type control group and a siRNA group were set up by infecting wildtype HepG 2 cells and p53 low expressing HepG2 cells with type 2 dengue viruses,respectively.The virus titers in two dif-ferent cells were determined by plaque forming assay using Vero cells .Indirect immunofluorescence assay was performed to detect virus multiplication .The apoptosis of virus infected cells were analyzed by flow cytome-try.ELISA was performed to analyze the levels of IFN-βsecreted by infected cells from two groups .Results Compared with wildtype control group ,the cells in siRNA group showed a suppressed expression of p 53 pro-tein,suggesting that the HepG2 cell line with low p53 protein expression was successfully established .The vi-rus titer in supernatants of the cells from siRNA group was about 100-fold higher than that of wildtype control group at 24 hours after viral infection .Fluorescence activated cell sorting analysis showed that the numbers of green fluorescence labeled cells were remarkably increased in siRNA group .We speculated that p53 protein might play a role in the inhibition of dengue virus infection as indicated by the observed results .The numbers of apoptotic cells showed no significant difference between two groups .However,the level of IFN-βsecreted by wildtype HepG2 cells was six times higher than that of the cells in siRNA group .Conclusion p53 pro-tein might inhibit dengue virus infection through the activation of type Ⅰ interferon signaling pathway rather than enhance cell apoptosis .

Objective To investigate the clinical and imaging features of the aquaporin-4 (AQP4)antibody-negative binocular optic neuritis and to analyze the predictive factors of visual function outcome.Methods Fifty-eight patients with AQP4-negative binocular optic neuritis were reviewed and followed up from January 2014 to December 2015.Patients at baseline and at the end of follow-up were evaluated for visual function and neurological examination.All patients underwent optic nerve and brain MRI, cerebrospinal fluid and routine laboratory tests.Results AQP4 antibody-negative binocular optic neuritis accounted for 9.4%(58/615)of the total optic neuritis in the same period.At baseline, 99 eyes (85.3%,99/116)had best corrected visual acuity<0.1.At the end of follow-up, 31 eyes(26.7%,31/116) had best corrected visual acuity < 0.1. There were 43 cases (74.1%, 43/58) with multi-segment involvement of optic nerve at the baseline.Baseline visual acuity(P=0.005), early treatment response (P=0.011), and segment numbers of optic nerve involvement(P=0.025)were independently associated with end-point outcome of visual function.Forty-nine patients(84.5%,49/58)showed monophasic course in (3.1 ± 0.9) years follow-up period, 7 cases (12.1%, 7/58) had recurrence, and 2 cases (3.4%, 2/58) converted to neuromyelitis optic spectrum disorder (NMOSD). Conclusions AQP4 antibody-negative binocular optic neuritis is common and the recovery of visual function is not satisfied. Baseline visual function and the length of optic lesion in MRI is related to the end-point prognosis. Most patients performs the single phase course during the follow-up period.

OBJECTIVE：To study the effects of costunolide on the proliferation ，migration and apoptosis of breast cancer SK-BR-3 cells and its mechanism. METHODS ：SK-BR-3 cells in logarithmic growth period were collected and cultured with different concentrations （10，20，30，40，50 μmol/L）of costunolide for 24，48，72 h. Inhibitory rate of costunolide on cell proliferation was detected with CCK- 8. The cells were divided into blank control group and costunolide group （10，20，30 μmol/L）. Hoechst 33258 fluorescence was used to observe the morphology and apoptosis of cells ，and apoptotic rate of cells were calculated. Cell scratch test was used to detect the migration ability of cells and calculate the migration rate. Western blotting was used to detect the relative expression level of Bcl- 2，Bax，Caspase-3 and Cleaved Caspase- 3 in cells. RESULTS ：The proliferation of SK-BR-3 cells were significantly inhibited by costunolide （P＜0.05 or P＜0.01），and it shows a trend of concentration and time dependence. In the blank control group ，cells possessed clear contour ，regular shape and good adherence . Compared with blank control group，the number of cells were decreased significantly in 10，20，30 μmol/L costunolide groups，the cell structure was loose，the volume was reduced ，and the gap became larger ，and most of the cell contour disappeared and became round ，the cell adherence was poor ；cell migration rate and Bcl- 2 protein relative expression level were decreased significantly ，while apoptosis rate and the relative expression level of Bax ，Caspase-3 and Cleaved Caspase- 3 protein were significantly increased （P＜0.05 or P＜0.01）. CONCLUSIONS ： Costunolide can inhibit the proliferation and migration ，and induce apoptosis of human breast cancer SK-BR- 3 cells，mechanism of which may be through up-regulating the expression of Bax ，Caspase-3 and Cleaved Caspase- 3 while down-regulating the expression ofBcl-2.