Objective To investigate the risk factors and their prevention and treatment approaches for occurring radial artery spasm (RAS) during the brain digital subtraction angiography (DSA) with transradial catheterization in patients with ischemic cerebrovascular disease.Methods The patients who underwent DSA of transradial approach because of ischemic cerebrovascular disease were enrolled.Their clinical data,surgical complications,and radial artery spasm were collected.The data of occurring RAS or not during DSA of transradial approach in patients were compared.Multivariate logistic regression analysis was used to analyze the risk factors for occurring RAS during DSA of transradial approach.Results A total of 100 patients with ischemic cerebrovascular disease who underwent DSA of transradial approach (74 ischemic stroke,26 transient ischemic attack) were enrolled,of which 21 (21％) had RAS.Of the 21 patients with RAS,4 suspended their operations and completed their DSA after spasm relief; another 17 were treated with intrathecal cocktail (heparin 2500 U,nitroglycerin 0.5 mg,verapamil 1.25 mg) and completed their DSA after spasm relief.There were significant differences in the proportions of radial artery diameter (1.89 ±0.28 mm vs.2.12 ± 0.17 mm; t =1.582,P =0.041),duration of operation (12.3 ± 3.1 min vs.9.8 ±2.7 min; t =1.264,P =0.038),and radial artery diameter ＞2 mm (9.52％ vs.65.82％ ;x2 =9.624,P =0.002),radial artery anatomy variation (23.81％ vs.0.27％; x2 =14.185,P＜ 0.001),and the first successful puncture (42.86％ vs.78.48 ％ ;x2 =5.335,P =0.021) in patients between RAS group and the non-RAS group.Multivariate logistic regression analysis showed that the radial artery anatomy variation (odds ratio [OR] 1.940,95 ％ confidence interval [CI] 1.372-2.241; P=0.023) was an independent risk factor for the occurrence of RAS.Radial artery diameter ＞2 mm (OR 0.752,95％ CI 0.352-0.847;P=0.043) and the first successful puncture (OR 0.843,95％ CI 0.367-0.941; P=0.045) were the independent protective factors for RAS.Conclusions RAS is a common complication of DSA of transradial approach.Repeated puncture,radial artery diameter,and radial artery anatomy variation are its most important influencing factors.

AIM:The limitation of materials' strength results in the external fixation of patients with patellar fracture following absorbable screw fixation.This study was aimed to guide the patients do progressive rehabilitation and observe the recovery of knee joint function.METHODS:Totally 35 patients with patellar fractures were enrolled from the Sixth People's Hospital in Shanghai Jiao Tong University between June 2004 and June 2006,including 27 cases of transverse fractures and 8 cases of comminuted fractures.They were all treated with BIOFIX self-reinforced poly-lactide absorbable screws,which were produced by Finland BIONX Company.Postoperatively isometric contraction training of quadriceps femoris was followed,and then progressive knee joint range of motion was carried out.The curative effect was evaluated by the recovery of knee joint function and radiograph.Normal knee joint function was taken as excellent effect,while nearly normal knee joint function and slightly poor squatting were taken as good effect.RESULTS:All the patients completed the treatment and rehabilitation,followed up for no less than 12 months,with a mean of 22 months.The average healing time was 6 weeks,excellent result cases were seen in 29 patients and good in 6.There was two cases occurred postoperative complications(wound swelling).CONCLUSION:Self-reinforced poly-lactide absorbable screws for treatment of patellar fractures and appropriate postoperative rehabilitation is believed to prevent the second operations.

Objective:This study was aimed to investigate the influence of CDK7 siRNA on the sensitivity of endometrial carci-noma cell line HEC-1-A to cisplatin (DDP)-based chemotherapy. Methods:Different CDK7 siRNA fragments were synthesized based on the designs of the CDK gene sequence and were transfected into HEC-1-A. Real time reverse transcription polymerase chain reac-tion (RT-PCR) and Western blot analysis were employed to demonstrate the effects of transfection. The best CDK7 siRNA was chosen to specifically silence CDK7 expression in HEC-1-A.The sensitivity of the cells to DDP therapy before and after transfection was deter-mined by methyl thiazol tetrazolium (MTT) cytotoxicity assay, flow cytometry, and Hoechst/PI double-staining fluorescence microsco-py. Results:A total of four different CDK7 siRNA segments were designed and successfully transfected into HEC-1-A cells. The inter-ference effect in each group was confirmed by real time RT-PCR and Western blot assays. CDK7-423 was determined as the best per-forming CDK7 siRNA (over 70%) to transfect into HEC-1-A cells. MTT cytotoxicity test showed that IC50 of DDP decreased to a range from 45.122 μg/mL and 3.200 μg/mL after inhibition of CDK7 expression. DDP toxicity to the endometrial carcinoma cells sig-nificantly increased (P<0.05). Flow cytometry revealed that the average cell apoptosis rate significantly increased after the inhibition of CDK7 expression (11.66%to 37.57%, P<0.05). Similar results were observed using Hoechst/PI double-staining fluorescence microsco-py, and the number of apoptotic corpuscle demonstrated an apparent increase in the low CDK7-expressing group compared with the pa-rental cells. Conclusion:After the downregulation of CDK7 expression by CDK7 siRNA transfection, DDP chemotherapy sensitivity and apoptosis of endometrial carcinoma cells significantly increased. Further research is anticipated on the use of CDK7 as a new treat-ment target for endometrial carcinoma.

Cerebrovascular Intervention is to study the subject of diagnosing and treating cerebrovascular disease with interventional endovascular techniques monitored and guided by neuroimaging. With the continuous development of computer, imaging and angiography techniques, their study method and category are being innovated and expanded continuously in recent years. This article reviews the novel techniques of imaging diagnosis, intra-arterial thrombolysis, angioplasty and endovascular embolization in cerebrovascular diseases, and also evaluates their clinical applications.

Objectives:To study the role of COX-2 and bFGF in the development of oral squamous cell carcinoma(OSCC).Methods:The expressions of COX-2 and bFGF were exmined by immunohistochemical staining with anti-COX-2 and anti-bFGF monoclonal antibodies respectively in 23 cases of OSCC,25 of oral leukoplakia(OLK)and 10 of normal oral mucosa.Results:COX-2 was detected in 20/23 cases of OSCC,13/25 of OLK and 0/10 of normal oral mucosa(P

Using immunoenzymatic technique,we have observed the localization ofimmunoglobulins in human palatine tonsils,of patients suffering from chronictonsilitis and hyperplasia.The result as follows:1.Epithelium:The outer surface of tonsil is lined by stratified squamous epithelium,the epithelium rarely shows keratinization and lacks a well-defind and continuousbasement membrane.In the basal layer of epithelium,it is reticular structure andspaces between the cords of epithelium cells are filled with Ig~+ lymphocytes andplasma cells,the reticular structure is particularly pronounced near the crypts.Thisspecial structure is regarded as an expression of active immune function.In thesuperficial layer of epithelium,the predominate cells are Ig~- small lymphocytes,maybe T lymphocytes.2.Follicle:All follicles have germinal centres,especially hyperplastic tonsils.The follicle has polarity,each follicle may be divided into three Zones(a b c),twozones(a b)form the centre of the follicle and the thired(c)is the mass of smalllymphocytes“capping”and enclosing the centre.The upper limits of zone(c)areoften indistinct,from the presence of many lymphocytes in the epithelium.Thedistribution of Ig~+ cells in follicle are different from their three zones.In the centre,IgG cells are most numerous,next most numerous are IgA~+ cells,and considerablyfewer IgM positive cells.In the c zone,only a few Ig~+ cells are seen(IgG IgM).Itis found that the germinal centre may produce more than one type of Ig,it differsfrom the report of Sordat,but quite agrees with Curran's result.However the numbersof cells containing the various types of Ig show a great difference.3.Other lymphoid tissue:The tissue between the follicles are rich in small Tlymphocytes and a few Ig~+ containing cells,this area was called thymic dependentarea.At an older age,this region is always enlarged,but the density of the cellswill decrease,meanwhile much connective tissues are seen in the stroma.

Objective To investigate the expression of Bmi-1,Mdm2 and Ki-67 in extrahepatic biliary duct carcinoma and to evaluate their clinical significance. Methods The expression of Bmi-1.Mdm2 and Ki-67 was detected in 10 normal extrahepatic biliary duct tissue and 30 cases of extrahepatic billary duct carcinoma with immunohistochemic0al staining and the their clinical significance were analyzed. Results No POsitlVe Bmi-1 expression was found in 10 normal extrahepatie biliary duct cages, while 18 of 30 extrahepatic biliary duct carcinoma cases showed positive Bim-1 expression.The expression of Bmi-I in extrahepatic biliary duct carcinoma(60.0%)was statistically higher than that in normal extrahepatie biliary duct(P<0.05).The positive expression rate of Mdm2 in extrahepatic biliary duct carcinoma was significantly higher than that in normal extrahepatic biliary duct (56.7%vs 20.0%,P<0.05).The cases of extrahepatic biliary duct carcinoma with Ki-67 proliferation index higher than 5%reached 60.0%,while the Ki-67 index was all lower than 1%in 10 normal extrahepatic biliary duct tissue, suggesting the higher proliferating activity of extrahepatic biliary duct carcinoma.No differences were found in the expressions of Bmi-1,Mdm2 and Ki-67 among extrahepatic biliary duct carcinoma cases with different clinical pathological features. Conclusion The results indicate that the expression of Bmi-1 and Mdm2 up-regulation may play an important role in carcinogenesis of extrahepatic biliary duct caroinoma. No clinical significances of the expressions of Bmi-1,Mdm2 and Ki-67 are found in extrahepatic biliary duct carcinomas.

A total of 35 patients with hallus valgus (56 feet) received treatment at the Department of Orthopedics, the Sixth People's Hospital, Shanghai Jiao Tong University between January 2004 and June 2005 and were recruited into this study. These patients underwent osteotomy of proximal first metatarsal and internal fixation with poly (L-lactic acid) (PLLA) absorbable pins. All patients were followed up for 4-22 months. Excellent outcomes were found in 27 patients (44 feet) and good results in 8 patients (12 feet). The mean healing time of surgical region was 6 weeks, nonunion or delayed union was not found. There were 3 cases suffering from complications post surgery. Two of them presented with peripheral wound red swelling, considering as a result of extraneous material-caused aseptic inflammatory reaction. This phenomenon would be regressed 2-4 weeks after hydropathic compress of ethanol gauzes and timely renewal of dressings. There was 1 case who suffered from protrution of absorbable pin 1 week after fixation and received reposition and plaster fixation. Bone displacement and nonunion were not found. This complication maybe results from excessively large bone pore due to shaking of electrodrill, which leads to loosening of absorbable pins.

BACKGROUND: Pterygium is associated with local chronic inflammatory responses and chronic stimulation from external factors such as. sunlight and wind dust. Presently. there are various theories concerning the onset mechanism of pterygium, but these theories are not generally accepted.OBJECTIVE: To investigate histopathological chractefistics of pterygium and analyze the mulfipotent stem cell effects on the onset of pterygium DESIGN: An open experiment.SETTING: Zhongshan Ophthalmic Center of Sun Yat-sen University.MATERIALS: Experiments were performed at the State Key Laboratory of Ophthalmology, Sun Yat-sen University from September 2006 to January 2007. 218 pterygial paraffin specimens following clinical and pathological diagnosis were obtained from Pathology Lab of Zhongshan Ophthalmic Center, Sun Yat-sea University.METHODS: Pterygial specimens harvested from clinical operations received morphology, immunohistochemistry and immunofluorescence under a confocal microscope.MAIN OUTCOME MEASURES: Morphology of ptorygium and expressions of CD34, vimentin (VIM), smooth muscle acfin (SMA), S- 100 in pterygium.RESULTS: Changes in morphology: Fibroplasia and neovascularization were the main changes in pterygium. Fibroplasia wasdiverse in different regions, and two main phenomena were observed. First, the tissues arranged tightly like the scleral fiber.Secondly, in some loose region, some of spindle-shape, polygonal, asteroid fibroblast-like cells, arranging loosely, could be seen only. No apparent collagen fibers were identified between them. Immunohistochemistry were positive for CD34 in some region where the fibroblast actively proliferated, whereas fibrocytes in mature fibrous tissue were negatively stained.Immunohistochemisu'y was positive for VIM in a large fraction of fibrocytes, vascular endothelial cells, vessel wall and perithelial cells. SMA staining was positive in basophilous small blocks, spindle or irregular cell cluster. Of the 218 cases, 56 cases had smooth muscle. S-100 staining demonstrated that neurofilament protein and adipocytes were positive. Of the 218 cases, 44 cases had adipose tissue, Immunofluorescence showed that proliferative active cells were positive and stained green under a confocal microscope.CONCLUSION: The fibrous tissues in pterygium originate from mesenchymal stem cells, and can differentiate into smooth muscle and adipose tissue.

Objective To investigate effects of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) using partial peroneus longus tendon autograft in treating recurrent patellar dislocation.Methods Forty-six patients (53 knees) with recurrent dislocation of patella received autologous partial peroneus longus tendon grafting for MPFL reconstruction after arthroscopic lateral retinaculum release from May 2009 to April 2010.Anatomic relation between femoral trochlea and patella,and motion path of patella were observed arthroscopically in adjustment of flexion and extension strength of grafted tendon in different angles.Successively,the tendon ends were fixed within bone tunnel of medial femoral condyle by using absorbable interface screws with synchronous superomedial displacement of tibial tuberosity.Stability of patellofemoral joint,dislocation recurrence,subjective symptoms of affected knees and general function recovery condition of affected limbs were studied.Results All patients were followed up for average 18 months (range,12-24 months),which showed the improvement of knee joint stability,without recurrence of patellar dislocation.Apprehensive test was negative.Axial X-ray films and CT of patella showed normal anatomical relation of patellofemoral joint.The Kujala patellar stability questionnaire scored (54.6 ±5.4) points before operation and (92.3 ±8.9) points after operation (t =55.41,P ＜ 0.01).All patients showed some improvement of motor ability after operation.CT examination showed that the congruence angle of patella and femoral trochlea was improved from preoperative (27.8 ± 8.1) ° to postoperative (2.3 ± 9.4) ° (t =20.87,P ＜ 0.01).Otherwise,ankle joint in the tendon donor site acted well,with normal function.Conclusion Arthroscopic lateral patellar retinaculum release and MPFL reconstruction using partialperoneus longus tendon autograft are effective in treatment of recurrent patellar dislocation in combination with superomedial displacement of tibial tuberosity,and avoid potential complications in tendon removal from around knee joint.