The vertebral artery dissection may be associated with the structural abnormalities of vascular wall or enviromental factors.The symptoms are usually caused by the luminal stenosis or the formation of blood clot,including the pain in posterior neck or mastoid region with local neurological deficits.The diagnostic methods for vertebral artery dissection include digital subtraction angiogaphy,magnetic resonance imaging,CT angiograpby and color Doppler ultrasonography.Anticoagulation is the main treatment option for most patients with vertebral artery dissection.

Fifteen cases with atrial myxoma in our hospital from May 2001 to Dec 2008 were retrospectively analyzed.Patients presented with a variety of symptoms mimicking mitral valve disease,including palpitation, shortness of breath and activity intolerance.Pulmonary and systemic embolizations occurred in three patients and sudden syncope in one.Radiograph and echocardiography can help to reveal atrial myxoma.Definite diagnosis was made based on histological examinations.In 6 months - 6 years'follow-up one case recurred.Surgical treatment should be prompted once diagnosis established.Tumor pedicle must be completely removed to prevent recurrence.

Objective:To construct a recombinant adenovirus vector harboring fusion gene NT4-p53(N15)-Ant,laying a foundation for gene therapy research of malignant tumors.Methods:The p53(N15)-Ant gene was obtained by T-vector method and was inserted in pBV220/NT4 vector after digested with restriction enzyme.The fusion gene of NT4-p53(N15)-Ant was subcloned into the shuttle plasmid of adenovirus;the products were cotransfered into HEK-293 cell line with helper plasmid PJM17.The recombinant adenovirus was produced by homologous recombination of above 2 plasmids in HEK-293 cells and its titer was measured by plaque-forming.The expression of Ad.NT4p53Ant in transfected 293 cells was confirmed by reverse transcription polymerase chain reaction(RT-PCR)procedure.The effect of Ad.NT4p53Ant on HepG2 cell line was measured by a colorimetric 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide(MTT)assay.Results:The p53(N15)-Ant gene was confirmed by restriction enzyme digestion and DNA sequencing.High titer of recombinant adenovirus was obtained by homologous recombination in HEK-293 cells(1?10 11pfu/ml).The expression of NT4-p53(N15)-Ant gene in 293 cells was confirmed by RT-PCR.Ad.NT4p53Ant had strong killing effect on HepG2 cells.Compared with Ad.GFP,Ad.NT4p53Ant significantly decreased the survival rate of HepG2 cells.Conclusion:The recombinant adenovirus vector encoding gene NT4-p53(N15)-Ant has been successfully constructed in this experiment by molecular cloning and in vitro recombination techniques,laying a foundation for further research of gene therapy of cancer.

Objective To construct the expression box of fusion gene NT4-p53(N15)-Ant.Methods The gene of p53(N15)-Ant was obtained by PCR of two primers templating with each other and T-vector cloning method.The positive clone was identified and analyzed by the restriction enzymes and sequencing respectively.After digested with restriction enzyme,the interest gene of p53(N15)-Ant was subcloned into the plasmid pBV220/NT4.Results The gene of p53(N15)-Ant was confirmed by the digestion of restriction enzyme and sequencing.The recombinant plasmid pBV220/NT4p53(N15)Ant was identified by the digestion of restriction enzyme and agarose gel electrophoresis and the results conformed theoretical values.Conclusion The plasmid pBV220 containing the expression box of NT4-p53(N15)-Ant was successfully constructed by molecular cloning and recombination techniques in vitro,which will guide further study on gene therapy of cancer.

Objective To discuss the differences and causes of earlier and later complications of nitinol stent implantation for patients with benign or malignant tracheobronchial stenosis.Methods Sixty patients with tracheobronchial stenosis analyzed retrospectively the incidence of earlier and later complications of nitinol stent implantation.Results In the earlier period,the incidence rate of postoperative hemoptysis of patients with malignant tracheobronchial stenosis was higher than that of benign patients, but its incidence of granulation tissue formation in airway was less than that of benign ones.In the later period, the incidence of pulmonary infection and granulation tissue formation of patients with malignant tracheobronchial stenosis were higher than those of benign ones. Conclusions It is more effective modus with nitinol stent implantation for patients with airway stenosis, but there were great differences of postoperative complications between malignant and benign tracheobronchial stenosis.

Objective To investigate the effect of partial nephrectomy of anatomical solitary kidney on tumor control and renal function preservation.Methods 10 patients with anatomical solitary kidney underwent partial nephrectomy from December 2007 to May 2016,including 6 males and 4 females ranged from 38 to 71 years old with an average of 57 years old.The PADUA score ranged from 6-10,with an average of 7.6.The tumor diameter ranged from 1.0 to 7.4 cm,with an average of 3.2cm.Results 7 cases underwent laparoscopic surgery.3 cases underwent open surgery.Mean operation time was 168min (ranged 103-217min).Mean blood loss was 135ml (ranged 20-400ml).The renal arteries were blocked in all patients.The ischemia time ranged from 9 to 33min,with an average of 20.6min.The mean estimated glomerular filtration rate at one week after surgery [40.7ml/(main · 1.73 m2)] decreased 44.7％ compared with pre-operation [73.6 ml/(min · 1.73 m2)].Acute kidney injury developed in 2 patients.One required temporary dialysis.The other improved after conservative treatment.There were no other complications such as urinary fistula and hemorrhage.The pathology analysis confirmed that 2 cases were angiomyolipoma,one case was benign cyst,6 cases were renal clear cell carcinoma,and one case was multilocular cystic renal cell carcinoma.4 cases were stage pT1a,one case was stage pT1b,one case was stage pT2a,and one case was stage pT4.Positive margin was found in one case.The average follow-up period was 28.2 months(ranged 3-58months).Only one patient need long-term dialysis 20 months after surgery at the latest follow up.Another patient had local recurrence and ipsilateral adrenal metastasis.Conclusions Satisfactory effect of tumor control and renal function preservation can be achieved by partial nephrectomy in solitary kidney,which prevent or delay the occurrence of hemodialysis effectively.

Objective To screen the plasma differential expressed proteins in patients with Crohn's disease(CD)and ulcerative colitis(UC)using surface-enhanced laser desorption ionizationtime of flight mass spectrometry,and to establish decision trees algorithms.Methods The plasma samples from 24 UC patients,25 CD patients and 25 healthy controls were analyzed with CM10 protein chip.The proteomic spectra of CD,UC and inflammatory bowel disease(IBD)were compared with controls respectively.The differential proteins that significantly altered expression levels were selected to establish decision trees algorithms of CD.UC and IBD and then blind validations were tested.Results In the range of m/z 2000-30 000,differential expressed proteins that changed at least 2-fold between CD and controls were 9.between UC and controls were 5,and between IBD and controls were 11(P＜0.05).The software automatically picked up the m/z 8208 and 8837 as decision trees algorithms for differentiating CD from controls and m/z 6985 for differentiating UC from controls as well as m/z 8208,1752,28840 and 1702 for differentiating IBD from controls.The sensitivities of decision trees algorithms for CD,UC and IBD were 96%,82%and 91%respectively,and the specificities were 100%,85%and 100%respectively.Conclusions The protein of m/z 8208 which has high sensitivity in differentiating CD from controls is worthy of further study.

Objective To evaluate the effect of the expression of P-glycoprotein (P-gp) in tumor tissue on analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain. Methods One hundred and fifty advanced cancer patients with pain aged 51-64 yr weighing 54-65 kg were included in this study. The expression of P-gp was negative in the tumor tissue in 50 patients (group M1 and B1, n = 25 each) and positive in 100 patients (group M2 ,M3 ,and B2 ,B3, n =25 each). The PCA regimen for the 6 groups were listed in the table .Pain was assessed with VAS scores (0 = no pain, 10 = worst pain) and venous blood samples were taken for determination of blood morphine/buprenorphine concentrations at 4, 12, 24 and 48 h of PCIA. Results The six groups were comparable with respect to age, body weight, M/F sex ratio, types of cancer, baseline pain level and education. The analgesic efficacy of morphine and buprenorphine was better ( VAS scores were significantly lower)in P-gp expression negative patients (group M1 and B1 ) than in P-gp expression positive patients (group M2 and B2 ). Higher doses of morphine and buprenorphine provided better analgesic efficacy in P-gp expression positive patients in group M3 and B3 than in group M2 and B2. Plasma morphine and buprenorphine concentrations were comparable between group M1 , B1 and M2, B2 and were significantly higher in group M3 and B3 at each time point. Conclusion Positive P-gp expression in the tumor tissue can decrease the analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain.

OBJECTIVE: This study was conducted to evaluate the percutaneous absorption of aconitine and mesaconitine in extracts of Radix Aconitum kusnezoffii. METHODS: The extracts of Radix Aconitum kusnezoffii were collected by using Franz diffusion cells after permeation through the skin of rats. Then rate constants of skin permeation of aconitine and mesaconitine were determined by high-performance liquid chromatography (HPLC). RESULTS: Under the condition that the concentrations of azone and propylene glycol were both 4%, the cumulative doses of skin permeation (Q) of mesaconitine and aconitine in the extracts of Radix Aconitum kusnezoffii (600 mg/ml) for 24 hours were 165.819 and 487.747 microg/cm(2) respectively, and their rate constants of skin permeation were 18.391 and 78.805 microg.cm(-2).h(-1) respectively. CONCLUSION: The aconitine and mesaconitine in the extracts of Radix Aconitum kusnezoffii can penetrate well through the skin of rats. Propylene glycol and azone can promote this penetration effects. The formula of skin permeation of mesaconitine and aconitine is in accordance with Higuchi equation and there is a linear relationship between Q and t(1/2).

By analyzing the traditional educational mode and subject of the higher medical education, the basic method and emphasis of the experimental class of the clinical medicine educational innovation have been established, and the general frame of the educational innovation content has been constructed, the executive essential point and point in the content of the educational innovation have been made. After several years of the practice and positive exploration, the class has achieved success.