Objective To discuss appropriate strategy about treatment of rotatory fixation or dislocation of atlantoaxial articulation in children. Methods 32 cases of rotatory fixation or dislocation of atlantoaxial articulation in children were analyzed retrospectively from January 2000 to March 2005, 24 males and 8 females; patients' age was from 3 to 12 years old with an average of 5.5 years old. The mean course of diseases was 6.5 weeks (range: 2 days to 50 weeks). According to Fielding-Hawkins clinical classification, typeⅠ17 cases(1 case with os odontoideum), type Ⅱ 12 cases(1 case with os odontoideum and 1 case with congenital absence of the arch of posterior atlas), type Ⅲ 3 cases. 26 cases received conservational treatments which were recommended as 2-3 weeks of cervical traction, traction weight should be controlled to 1.0-1.5 kg. After a successful reduction a proper external fixation was required to maintain reduction. And another 6 serious cases received posterior atlantoaxial or occipitocervical autograft fusion. Indications for posterior atlantoaxial or occipitocervical atuograft fusion includes: 1) have difficulty in reduction even under proper traction; 2) with obvious neurological symptoms; 3) combined with compensatory deformity of atlantoccipital articulation or other occiptocervical deformities. Results All of 32 cases were followed up from 3 to 50 months with an average of 32 months. 26 cases who received cervical traction and external fixation resulted in satisfactory outcome in which all the torticollis were rectified, bilateral masses were symmetrical on AP position, and ADI was less than 4 mm in dynamic extension and flexation lateral view. ROM in rotation and extension and flexion were completely recovered. All the 6 cases surgically treated obtained sound bony fusion and neural symptoms were improved obviously and torticollis were rectified completely in 4 cases and others (2 cases) stopped progressing after operation. Conclusion Conservative treatment including Glission traction, cranial traction, collar, cast or cervicothoracic external fixation has been proved to be very effective in most of rotatory fixation or dislocation of atlantoaxial articulation in children; however, operative treatment should be considered in the following situations: patients with difficulty in reduction, with neural involvement and compensatory deformity of atlantoccipital articulation or other occipitocervical deformities.

Objective To analyze diagnosis and management of traumatic atlantal fractures complicated with disruption of the transverse atlantal ligament. Methods Twenty-six patients with traumatic atlantal fractures complicated with disruption of the transverse atlantal ligament, 20 acute ones and six old ones, were managed in our department from March 1995 to March 2005. All the patients had the symptom of neck pain and a certain extent of neurological deficits. The radiographic examination showed that there were fractures in the anterior arch or/and lateral mass of the atlas and that the atlanto-dental interval (ADI) in these patients was 4 to 7 mm. Twenty-one cases were operated on with occipitocervical or atlantoaxial fusion immediately after injury. Five cases received conservative treatment. Results All were followed up for 15 (from 6 to 24) months on average. The 21 cases treated operatively reported relieved symptoms. Four of the five conservative treatments succeeded, but one of them underwent a successful atlantoaxial fusion because the original conservative treatment had failed. Conclusions The severity of clinical symptoms mostly depends on the degrees of atlantal displacement and cord compression. Diagnosis should be made on the basis of the ADI change as well as clinical presentations. For patients who have potential risk of atlantoaxial instability, occipitocervical or atlantoaxial,usion should be performed early.

Objective In the present study, we observed the distribution of nitric oxide synthase positive neurons in the developing rat telencephalon and to realize the possible roles of NO in brain development further. Methods NADPH-d histochemical method was used to investigate the micromorphology and distribution of NOS positive neurons in rat telencephalon from embryonic day 14 (El4) to postnatal day 14 (P14). Results At El4, no neurons stained. Labeling was observed in the ventrolateral of the striatum at E15. At E17, positive neurons were seen in the cerebral cortex and piriform cortex. They were cells with small cell bodies, shorter dendrites and less ramification. The stained neurons were either increased or maintained in both number of neurons and intensity during development. At E20, positive cells were found in many regions. Many positive neurons were present in the piriform cortex, ventrolateral of the striatum and bed nucleus of the stria terminalis. They acquired larger size and more complex dendrites. After birth, intensely stained NOS positive fibers were distributed widely in the cerebral cortex and striatum. Stained cells were found in the corpus callosum and hippocampus also. The distribution pattern of positive cells at P14 was essentially similar to that reported in adult rats. Conclusion The distinctive temporal and spatial expression pattern of nitric oxide synthase positive neurons in the telencephalon indicated that NO may play an important role in brain development and maturation.

0.05). Conclusions Autop-hagy/lysosomal pathway was activated immediately after recurrent seizures as indicated by the elevated expression of Beclin1 in cerebral cortex. 3-MA was involved in the regulation of autophagy/lysosomal pathway by down-regulating the expression of Beclin1.

Objective To study the detective sensitivity for position of multi-leave collimators ( MLC) using Delta-4. Methods First,the small positional deviation of MLC was simulated and measured using the linac (Varian,Trubeam) equipped with EPID.Then,two beam fields 2. 0 cm (x)×6. 0 cm (y), 7. 0 cm (x)×6. 0 cm (y) were designed,the x1 and x2 of MLC were expanded 0. 1 mm,0. 2 mm,0. 3 mm... 0. 9 mm and 1. 0 mm,2. 0...5. 0 mm to external simultaneously,different parameters of 3 mm/3%,2. 5 mm/2. 5%,2 mm/2%, 1. 5 mm/1. 5% and 1 mm/1% were used in Gamma analysis to analyze the difference between dose distribution detected by Delta-4 and original dose distribution with unexpanded MLC position derived from TPS. Results For 2. 0 cm ( x) × 6. 0 cm ( y) beam field, the pass rate of original dose distribution was 100%,and that decreased to 95. 5% when x1 ,x2 of MLC were expanded 0. 3 mm to external, and decreased to 89. 4% when expanded 0. 5 mm at 2. 5 mm/2. 5% statistical standards. For 7. 0 cm ( x) × 6. 0 cm ( y) beam field,the pass rate of original dose distribution was 96. 5%,and that decreased to less than 95% when x2,x2 of MLC were expanded 0. 3 mm to external,and passing rate was above 90% when MLC expanded less than 0. 5 mm at 1. 5 mm/1. 5% statistical standards. Conclusions For MLC' s positional deviation in decimillimeter level,raise standards of Gamma analysis properly may improve the capability of Delta-4 for detecting small positional deviation,but it won' t detect all the positional deviation of MLC in decimillimeter level. For different size of beam field,it is proposed to use different analytical standards for Delta-4.

Hilar cholangiocarcinoma is a type of malignant tumor of the extrahepatic ductal system.Due to hepatic artery and portal vein involvement within the liver hilum,the resection rate is low and the prognosis is poor.However,with several advances in imaging technology achieved during the last decades,the accuracy of diagnosing and assessing the resectability of hilar cholangiocarcinoma has been greatly improved.In fact,some new classification and staging systems have been proposed to evaluate the tumor.This review will discuss the recent advances in the classification,staging,and preoperative resectability assessment for hilar cholangiocarcinoma.

Objective To explore the repetitive expressions of autophagy marker protein-rnicrotubule-associ-ated protein 1 light chain 3 (LC3) in hippocampus in newborn rats with recurrent seizure and the influence of 3-methyladeine (3-MA) on LC2 expressions. Method Seventy-two 6-day-old SD rats were randomly (random nam-ber) divided into the recurrent neonatal seizure group (RS group, n = 24), the 3-MA-treated seizure group (3-MA group, n = 24) and control group (n = 24). Rats in RS group were subjected to 55 attacks of seizure induced by flurothyl in 9 successive days from the 6th postnatal day (P6). In 3-MA group, 2 μL of 3-MA was injected every day till seizure induced. Western blot analysis was used to determine LC3 protein level in hippocampus at different intervals of 1.5 h,3 h,6 h and 24 h after the last convulsion. The LC3 protein level was analyzed with Dunnett test after ANOVA. Results LC3 protein levels in RS group at the different intervals were significantly higher than those in the control group and in 3-MA group (F =4.70,5.28,8.51 and 5.89, respectively, P <0.05), and there were no significant differences in LC3 protein level between 3-MA group and control group at those intervals (P > 0.05). Conclusions The autophagy/lysosomal pathway is immediately activated after recurrent seizure evidenced by the elevated expressions of LC3 in hippocampus. The 3-MA is involved in the regulation of autophagy/ lysosomal pathway by down-regulating the expressions of LC3.

OBJECTIVETo compare the effective differences between deep needling and shallow needling at three acupoints around ear for subjective tinnitus.

METHODSFifty patients with subjective tinnitus were randomized divided into a deep needling group and a shallow needling group, 25 cases in each group. Twenty-two patients in the deep needling group and 20 patients in the shallow needling group were brought into statistic in the end. In the two groups, the three acupoints around ear and distal acupoints were both selected. The acupoints of the affected side such as Yifeng (TE 17), Tinghui (GB 2), Ermen (TE 21), Zhigou (TE 6), Zhongzhu (TE 3) and Hegu (LI 4) were adopted. Yifeng (TE 17), Tinghui (GB 2) and Ermen (TE 21) were acupunctured 30-38 mm in the deep needling group and 15-20 mm in the shallow needling group. The other acupoints were conventionally acupunctured in the two groups. The needles were retained for 30 min,once a day and five times a week for all patients. The treatment was continuously for 4 weeks in the two groups. Tinnitus handicap inventory (THI) scores, tinnitus grades and visual analogue scale (VAS) for tinnitus sound levels were observed before and after treatment, and the effects of the two groups were compared.

RESULTSThe total effective rate in the deep needling group was 59.1% (13/22), and it was better than 20.0% (4/20) in the shallow needling group (P < 0.05). In the deep needling, group, the THI score, tinnitus grade and the VAS score were improved than those before treatment (all P < 0.05). In the shallow needling group, the three above indices before and after treatment were not different in statistical significance (all P > 0.05). After treatment, all the three indices in the deep needling group were superior to those in the shallow needling group (all P < 0.05).

CONCLUSIONAcupuncture at the three acupoints around ear deeply could apparently improve tinnitus, and reduce tinnitus sound levels for subjective tinnitus. The effect is better than that by shallow needling at the three acupoints.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; Adult ; Aged ; Ear ; physiopathology ; Female ; Hearing ; Humans ; Male ; Middle Aged ; Tinnitus ; physiopathology ; therapy ; Treatment Outcome ; Young Adult

AIM: To investigate the signaling mechanisms involved in the priming effects of lipopolysaccharide(LPS) on heat killed Staphylococcus aureus(HKSa)-induced nitric oxide(NO) production in macrophages.METHODS: Murine macrophage RAW264.7 was used in the experiment.Griess reagent was used to measure the content of nitrite in culture medium.Real-time PCR and Western blot was utilized to examine the mRNA and protein levels of toll-like receptor 2(TLR2),respectively.Dual luciferase reporter assay was used to assess the transcriptional activity of nuclear factor of activated T cells(NF-AT).RESULTS: The RAW264.7 cells pretreated with LPS for 24 h significantly enhanced NO production induced by HKSa,suggesting that LPS primed the macrophages and increased the reactivity of the cells to HKSa.LPS increased the mRNA and protein levels of TLR2 in a dose-dependent manner in RAW264.7 cells.The RAW264.7 cells pretreated with LPS enhanced NO production induced by peptidoglycan,one of the specific ligand of TLR2.The priming effect of LPS on HKSa-induced NO production was partly blocked by TLR2 neutralizing antibody.LPS significantly enhanced the transcriptional activity of NF-AT,which was inhibited by BAPTA/AM(a cell-permeable cytosolic calcium chelator) and cyclosporine A(CsA,an inhibitor for calcineurin).Both BAPTA/AM and CsA inhibited the priming effect of LPS on HKSa-induced NO production in RAW264.7 cells.CONCLUSION: The present study confirms the priming effect of LPS on the reactivity of RAW264.7 cells to HKSa.Pattern recognition receptor TLR2 and calcium/calcineurin/NF-AT signaling pathway may be involved in the priming process initiated by LPS.

Purpose To explore the CT features of mediastinal cystic mature teratoma. Materials and Methods CT images of 11 patients with pathologically confirmed mediastinal cystic mature teratoma were retrospectively analyzed, distribution within mediastinum, shape of cysts, capsule contents density, walls of cysts and mass cardiovascular interface (MCI) were analyzed. Results All the 11 cases were located in the anterior mediastinum, including three cases confined to the anterior mediastinum, seven cases located mainly within or involving the anterior and middle mediastinum, and one case confined to the anterior inferior mediastinum. Nine cases were round, one case was oval, one case was half round. Seven cases with fat ingredients displayed within the lesions, four cases with fat nodules within the cystic walls;ten cases showed as cysts with significant walls;MCI protrude type in six cases and smooth type in five cases. Fat, hair, keratosis, mucus and other ingredients were found in each cavity in surgery and pathology examination. Conclusion CT features of mediastinal cystic mature teratoma are complex and diverse, but with certain characteristics, thus CT is of great significance in the diagnosis and differential diagnosis of mediastinal cystic mature teratoma.