In the complex set of biological processes that a particular malignancy to metastasize,tumor cells must adapt to different survival pressures.As an important cell-physiologic response that under regulation of many genes and their expressions,autophagy not only can be strongly induced to adapt to metabolic stresses and microenvironmental changes,but also involved in the process of epithelial-mesenchymal transition ( EMT),restcting inflammation,resisting anoikis,maintaining dormancy in the metastatic process.

BACKGROUND:Artificial valve replacement for valvular disease has good biocompatibility and hemodynamic characteristics, but there are stil many factors that affect its therapeutic effects. OBJECTIVE:To detect the level of serum Apelin-12 in the perioperative period of valve replacement in valvular disease patients with atrial fibrilation. METHODS: Sixty-two patients with valvular heart disease scheduled for artificial valve replacement were selected, including 30 patients with persistent atrial fibrilation (atrial fibrilation group) and 32 patients with sinus rhythm (sinus rhythm group). There were 33 males and 29 females, with a mean age of (55±11) years. Levels of serum Apelin-12 and makers related to inflammation and oxidative stress were detected in two groups at admission. Furthermore, the sinus rhythm group was sub-divided into postoperative atrial fibrilation (POAF) group (n=8) and non-POAF group (n=24) after valve replacement, and the above-mentioned indicators were detected and compared between these two subgroups. RESULTS AND CONCLUSION:Compared with the sinus rhythm group, the serum level of Apelin-12 was significantly lower in the atrial fibrilation group, while the levels of high-sensitivity C-reactive protein and interleukin-6 and total antioxidant capacity were significantly higher in the atrial fibrilation group (P <0.05). Correlation analysis showed that the serum level of Apelin-12 was negatively correlated with high-sensitivity C-reactive protein level and total antioxidant capacity (r=-0.265,P=0.045;r=-0.960,P <0.001), but not correlated with the interleukin-6 level (r=-0.155,P=0.230). Compared with the non-POAF group, the serum level of Apelin-12 was significantly lower in the POAF group (P< 0.05), but the left atrial diameter, high-sensitivity C-reactive protein level were higher in the POAF group (P < 0.05). Apelin-12 may take part in the occurrence and maintenance of atrial fibrilation through the regulation of inflammations and oxidative stresses. The testing of serum Apelin-12 has a certain value in predicting the occurrence of postoperative atrial fibrilation.

0.05 ),respectively. Conclusions:Modified radical neck dissection with internal jugular vein preservation may have similar therapeutic effect to radical neck dissection.

AIM: To explore the role of calcineurin i n th e expression of NF-?B and the neurotoxicity in cultured cortical neurons treate d with interleukin-1? (IL-1?) and NMDA. METHODS: The cultured rat cortical neurons were used in the expe riment, damage of neurons was induced by interleukin-1?(IL-1?) or excitator y amino acid (NMDA). The degree of neuron damage was examined with the methods o f MTT assay and LDH releasing rate assay, as well as the Annexin V and PI immuno fluorescence. The expression of NF-?B p65 on the neurons was tested by the West ern blot analysis. RESULTS: Viability of neurons was obviously lower in the IL-1? group and NMDA group respectively than that in control group (P0.05). Annexin V and PI immunofluoresc ence showed that IL-1? mainly induced the neuron apoptosis, and NMDA induced th e neuron necrosis. CONCLUSIONS: The calcineurin mediates the higher expression of N F -?B p65 and neuron damage induced by IL-1?, but not play a critical role in th e necrosis induced by NMDA in the cultured cortical neurons. These results indic ate that calcineurin is the key molecule in the apoptotic signaling pathway.

Objective To evaluate the long-term clinical efficacy of iliac bone block allograft in anterior reconstruction of thoracolumbar fractures.Methods A follow-up study was carried out on 93 patients with thoracolumbar fractures treated by anterior decompression and interbody fusion with iliac bone block allograft from February 2004 to March 2007.The radiographic and clinical outcomes were retrospectively assessed.Results Sixty-six patients were followed up for 60-97 months (mean,78 months).The effective interbody fusion rate was 100％,with the fusion time of 6-12 months (mean,10 months).The Cobb' s angle corrected from pre-operative (21.6 ± 8.3)° to post-operative (5.8 ±5.2)°,but when the infusion became effective,the angle showed average loss of 2.4°.All the 66 patients were associated with various degrees of neurological deficiency,but the patients with incomplete nerve dysfunction obtained different degree of recovery.Conclusions Iliac bone block allograft is effective in reconstruction of spinal anterior-middle column stability with the aid of internal fixation instruments.Thereby,it may be a potential alternative to autograft in the treatment of thoracolumbar fractures and can attain early and late stage persistent spinal stability.

Objective To describe the clinical features of patients with hemorrhagic fever with renal syndrome (HFRS) in popular period and other period.Methods All the HFRS patients from epidemic areas in Xi' an were surveyed retrospectively.The sociodemographic data,symptom characteristics and laboratory test results were collected.Chi-square test,rank test were used to analyze the data.Results Totally 429 HFRS cases were recruited including 280 male (65.3％) and the male/female ratio was 1.9 ∶ 1.Adults with 16-60 years of age were the main group,which accounted for 74.8％ of the total cases.The constituent ratios of cases with 16-60 years of age in popular period and other period were 76.1％ (245/322) and 71.0％ (76/107),respectively; the sex ratios were 1.93∶1 and 1.74∶1,respectively; the time from fever onset to hospitalization was 3 d and 4 d,respectively; the time of hospitalization was both 10 d; the proportions of emergency cases were 59.8％ (189/316) and 67.6％ (71/105),respectively; the proportions of cured cases were 56.4％ (181/321) and 43.4％ (46/106),respectively.The clinical features were not significantly different between popular period and other period (all P＞0.05).The immunoglobulin M (IgM) antibody positive rate was 85.4％ (315/369) and those in popular period and other period were 88.4％ (251/ 284) and 75.3％ (64/85),respectively (x2 =8.968,P＜0.01).There was a positive correlation between symptom severity and outcome of discharge (x2=18.558,P＜ 0.01),the more slight symptoms were related with the better outcome.Conclusion The clinical features are similar in cases from popular period and other period from Jan 2008 to Jun 2011.

Objective:To evaluate the clinical outcomes of 2 kinds of osteocutaneous flap in the treatment of mandibular osteoradione-crosis.Methods:35 cases with mandibular osteoradionecrosis were treated by partial mandibulectomy and bone graft according to de-fect size and patients'requirements.The defects in 7 patients were reconstructed with iliac osteocutaneous flap and 28 with fibular os-teocutaneous flap.All flaps and wounds were monitored regularly.Results:One flap with venin crisis was observed in the patients treated with iliac osteocutaneous flap,its skin island was failed but the bone graft was survived.In the fibular osteocutaneous flap group,3 flaps with vein crisis were observed.2 of them were failed and 1 was rescued after second surgery.The most common compli-cations were infection,delayed wound healing and scar.The appearance and function were all satisfied and limitation of mouth opening was improved after surgery.Conclusion:Both of fibular osteocutaneous flap and iliac osteocutaneous flap can be applied in the defect reconstruction of patients with mandibular osteoradionecrosis.Fibular osteocutaneous flap is a good choice for huge mandibular defect and iliac osteocutaneous flap seems more esthetical.

Objective To evaluate the clinical efficacy of pingyangmycin (PYM) injection on infantile hemangioma located in the parotid gland region. Methods Twelve patients were treated by intralesional injection of PYM. When necessary, the injections were repeated at an interval of one week, but not more than 3-4 sessions within a therapeutic period. Normally, the secondary therapeutic period was performed 1 month later. The general and local adverse responses were recorded and the clinical outcomes were assessed with a follow-up of 1 to 3 years. Results Complete clinical resolutions were achieved in 10 patients. 2 patients received one injection, 3 patients received 2 injections, 3 patients received 3 injections, and 2 patients received 4 injections. The remaining 2 patients with partial resolution received 6 and 7 injections respectively. No clinical recurrence was observed during the follow-up of 1 to 3 years. No ulcerations or postoperative sears in injection regions were presented. The function of facial nerve was remained normality in all patients. The systematic side effects included transient pyrexia and poor appetite appeared in partial patients. No allergy cases were found. Conclusion Treatment of infantile hemangioma located in parotid gland region with PYM injection reveals a high rate of complete clinical resolution, with fair cosmetic results and short treatment time, and it does not damage the facial nerve or form local scar.The treatment time of PYM injection seems to be positively related to size of the lesions.

Objective To study the imaging manifestations and clinical significance of simple cochlear nerve canal(CNC)stenosis. Methods The HRCT findings of 14 patients(1 7 ears)with simple CNC stenosis diagnosed sensorineural hearing loss(SNHL)were retrospectively analyzed.The width of CNC and internal auditory canal was measured and compared with the normal ears,the data were statisti-cally analyzed by SPSS1 6.0.Thin-sliced MRI of internal auditory canal (axial and oblique sagittal position)was performed in 8 cases. Results HRCT displayed obvious CNC stenosis in all 14 patients(1 7 ears),2 ears with cochlear nerve canal atresia.Width of CNC and internal auditory canal was (0.5±0.3)mm and (4.6±1.0)mm,it was (2.1±0.2)mm and (5.1 ±1.3)mm in normal ears (1 1 ears),the width of CNC was of significant difference between normal ears and ears with SNHL,and there was no statistical sig-nificant difference in width of internal auditory canal.12 ears(from 1 7 ears with simple CNC stenosis)were lacking of fissure in the cribriform area,1 1 ears(normal ear)were existence of fissure in the cribriform area;cochlear nerves were not shown in 8 patients with MRI examination.Conclusion CNC stenosis can be isolated from internal auditory canal stenosis,MRI could display cochlear nerve dysplasia(CND).

ObjectiveTo investigate an optimal treatment of localized low flow type venous malformation located in the oral and maxillofacial region.MethodsFifty seven patients with localized low-flow venous malformation were treated by intralesional injection of PYM.The injections was repeated at an interval of 10 to 14 days,but not more than 3-5 sessions within a therapeutic period.If necessary,the secondary therapeutic period was performed 1 month later.The general and local adverse responses and the appearance improvement were recorded.The clinical outcomes and aesthetic effects were assessed with a follow-up of 1 to 3 years.ResultsAfter 3-8 injections,complete clinical resolutions were achieved in 52 patients.The deformity disappeared thoroughly.The surface skin and the appearance of lesions showed normal.4 patients received completed lesion control and showed nor mal skin or muco but a little hypertrophy tissue.One venous malformation reduced 2/3 volume after 8injections but improved slowly.The therapeutic time seemed to be related with the size of lesion.Diameter less than 3 cm could be usually cured within 1 treatment period.No ulcerations or scars were presented in injection regions.The function of nerves in oral and maxillofacial region remained normality in all patients.The systematic complication included transient pyrexia and poor appetite appeared in several cases.No allergy was found.No clinical recurrence was observed during the follow-up.ConclusionsTreatment of localized low-flow venous malformations in oral and maxillofacial region with PYM sclerotherapy reveals a high rate of complete clinical resolution,a fair cosmetic and function result,and does not damage facial nerves or form local scars.And it might be regard as an optimal therapeutic method to localized low-flow venous malformations.