Objective To compare the efficacy and safety of vitrectomy combined with internal limiting membrane flap and vitrectomy combined with internal limiting membrane peeling for the treatment of idiopathic macular hole with different sizes.Methods A total of 127 consective patients (127 eyes)were divided into two groups according to the size of the hole diameter of the smallest split points by less than or equal to 500 μm (small diameter macular hole group) and more than 500 μm (huge diameter macular hole group).According to different surgical methods the patients were divided into non ILM flap coverage group (peeling 1 group and peeling 2 group) and ILM flap cover group (covering 1 group and covering 2 group).All the patients underwent vitrectomy combined with internal limiting membrane peeling or vitrectomy combined with limiting membrane flap.Preoperative and postoperative best correct visual acuity,closure ratio of macular hole and postoperative major complications were observed and followed up.Results The postoperative best correct visual acuity improved in all the groups,there was no significance difference between small diameter macular hole group and huge diameter macuiar hole group (t =0.112 2,0.750 8;all P ＞0.05).The closure ratio of peeling 1 group and covering 2 group at postoperative 6 months were all 100％,there was no statistical difference (P ＞ 0.05),which in peeling 2 group and covering 2 group were 84.85％ and 100.00％,there was statistical difference (x2 =13.292,P ＜ 0.05).There was no statistical difference in preoperative defect diameter of the inner and outer junction between peeling 2 group and covering 2 groups (P ＞0.05),there was also no statistical difference between peeling 2 group and covering 2 groups at postoperative 1 months (P ＞ 0.05),but there were statistical differences at postoperative 3 months,6 months and 12 months (all P ＜ 0.05),the covering 2 group were less than the peeling 2 group.Conclusion ILM flap coverage helps to heal macular holes greater than 500 μm diameter,and has no extra effect on healing of diameter less than 500 μm.

Objective To compare the accuracy of post-operative pain score ratings using three numerical rating scales(NRS) between the children,nurses and parents.Methods Cognitively intact children aged five to twelve undergoing all surgical procedures were studied.Thirty-one children were included in the study.The numerical rating scale was used to rate the children's pain by the children,nirses and parents on arrival to the PACU and prior to discharge.Results We found strong correlations between children's,parent's and nurses' pain scores on admission and discharge from PACU.The intraclass correlation coefficient of pain scores reported by children and parents was 0.948(95％CI,0.897～0.975) and 0.938(95％CI,0.877～0.970).The intraclass correlation coefficient of pain scores reported by children and nurses was 0.961 (95％CI,0.922～0.981),0.972(95％CI,0.944～0.986).The intraclaas correlation coefficient of pain scores reported by parents and nurses was 0.924 (95％CI,0.850～0.963),0.921 (95％CI,0.844～0.961).Conclusions The numerical rating scale appeared to be suitable for younger children.We found strong correlations between pain scores reported by children,nurses and parents using a numerical rating scale.

Objective To observe the effect of Ti-6AL-4V particles on morphological and func- tional changes of osteoclast in vitro.Methods Mature osteoclasts separated from New Zealand Rabbits were cultured on glass slices and cortical bone slices.The experimental group was stimulated by Ti-6AL- 4V particles at concentration of 0.1 mg/ml.The cells were stained with TRAP at different culture time to observe the morphological variety.The bone resorption pits on bone slices were stained by toluidine blue and the resorption areas analyzed by computer image analysis software.Results Osteoclasts phagocy- tosed the particles,with irregular shapes,deeper TRAP stain and earlier apoptosis.Stimulation by Ti- 6AL-4V particles brought about larger area of bone absorption lacuna.Conclusion Osteoclasts have the ability to phagocytose Ti-6AL-4V particles,which leads to morphological and functional changes and enhances bone resorption.

Objective To explore role of 64-slices spiral CT in differetiation of acute chest pains.Methods Thirty six patients with acute chest pains were performed 64-slices spiral CT chest angiography.Two-dimensional and three-dimensional reconstruction was performed in all patients by means of multiplanar reconstruction(MPR)(coronal,sgittal oblique),curved planar reformation(CPR), maximum intensity projection(MIP),and volume rendering(VR).All images were blindly reading by two experienced radiologist.DSA were performed at the same time in 16 cases.Results The coronary artery branches,pulmonary artery and aortic artery in all patients were showed clearly,The acute myocardial infarction were showed in 10 cases,The pulmonary artery embolism in 14 cases,The aortic dissection in 6 cases respectively,The Coronary embolism in One case ,pneumothorax In One case The constrictive pericarditis in 1 case respectively.Normal findings in 4 cases.Conclusion 64-slices spiral CT is a useful and noninvasive examination in acute chest pain.

Objective To investigate the expression of survivin and bcl-2 in human squamous cell carcinoma (SCC) lesions and cell line SCL-1. Methods Tissue samples from 60 patients with SCC and 10 normal human controls were immunohistochemically stained to detect the expressions of survivin and bcl-2.Western blot was used to measure the expressions of bcl-2 and survivin proteins in HaCaT human keratinocytes and SCL-1 human squamous cell carcinoma cells. Results In normal control tissues, there was no expressions of survivin or bcl-2, while in SCC, the expression rates of bcl-2 and survivin were 70% and 60%, respectively,and there was no statistical correlation between the expressions of bcl-2 and survivin (P >0.05). Neither the expression of survivin nor that of bcl-2 was correlated to patients' age, gender or lesional site (all P >0.05). A statistical correlation was observed between the pathological stage in patients and expression of bcl-2 as well as between lymph node metastasis and expression of survivin (both P < 0.05). Western blot analysis revealed a significant increase in the expression of survivin and bcl-2 in SCL-1 cells compared with HaCaT cells. Con-clusion In SCC, survivin and bcl-2 seem to play their roles via different anti-apoptotic pathways.

OBJECTIVETo study the diagnosis and microneurosurgical treatment of cavernous sinus neurinoma.

METHODSTwenty-two patients with cavernous sinus neurinoma which had been diagnosed by MRI were operated on by microsurgery. Fourteen patients received excision of tumor through frontotemporal approach with zygomatic osteotomy and, 8 patients via subtemporal and suboccipital transtentorial approaches.

RESULTSTotal resection was achieved in 21 patients (95.5%), and subtotal resection in 1. There was no operative death. The all operative samples were confirmed neurinoma pathologically. The symptoms postoperation such as headache and exophthalmos were reduced. Three months after operation, the function of the 6th nerve was improved in 12 of 19 patients with paresis of the 6th nerve. One patient with hemiplegia recovered well. The function of the 3th nerve recovered in 4 of 6 patients with recurrent paresis of the 3th nerve. Those patients with hydrocephalus were improved after operation. The patients were follow up 8 - 60 months (mean 20 months). No tumor recurrence was observed.

CONCLUSIONCavernous sinus neurinoma can be removed successfully via subtemporal and suboccipital transtentorial approaches.

Angiography, Digital Subtraction ; Cavernous Sinus ; pathology ; Cranial Nerve Neoplasms ; diagnosis ; surgery ; Female ; Humans ; Magnetic Resonance Angiography ; Male ; Microsurgery ; Neurilemmoma ; diagnosis ; surgery ; Neurosurgical Procedures ; Retrospective Studies ; Tomography, X-Ray Computed ; Trigeminal Nerve

OBJECTIVEDiscuss the surgical treatment of jugular foramen and hypoglossal canal tumor, and choice of the best surgical approach.

METHODS32 patients with jugular foramen and hypoglossal canal tumor were operated through the postauricular tran-supracondylar approach, 13 neurinoma, 7 glomus jugular tumors, 4 meningioma, 3 chordoma. 23 were total removed, with a subtotal of 9.

RESULTS21 patients were followed up, mean 2.5 years. 18 patients work normally, 7 of them were hoarseness, 2 of other 3 patients lived by themselves, 1 of existed obstruct of limbs.

CONCLUSIONSPostauricular tran-supracondylar approach exposes satisfactory for the dumbbell-shape tumors of intra-or extra cranial. It has high rate of total removal and low rate of complications. It is the best approach of treatment in jugular foramen and hypoglossal canal tumors. The outcome is good.

Adult ; Brain Neoplasms ; surgery ; Cranial Nerve Neoplasms ; surgery ; Female ; Glomus Jugulare Tumor ; surgery ; Humans ; Hypoglossal Nerve Diseases ; surgery ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Treatment Outcome

Objective To investigate the mechanism of the inhibitory effect of ?-ray irradiation on rat vascular smooth muscle cells(VSMC). Methods The ef fect of ?-ray irradiation on proliferation of VSMC was observed by 3?H-TdR incor poration. After ?-ray irradiation, the VSMC cell cycle change was detected b y flo w cytometry. The expression of p53, cyclin D and PCNA was investigated by Wester n Blot. Results The inhibitory effect of ?-ray irradiation on VSMC proliferati on was dose-dependent. After ?-ray irradiation, VSMC was arrested in G 1 st age, w ith the expression of p53 increased but the expression of cyclin D and PCNA decr eased. Conclusions ?-ray irradiation can inhibit the proliferation of VSMC. T he main mechanism is probably due to the induction of cell cycle arrest and inhi bition of the VSMC mitosis ,during which process, p53,cyclin D and PCNA all pla y an important role .

As one of the most serious types of psoriasis, pathogenesis of erythrodermic psoriasis (EP) is unclear so far. In this study, we aimed to detect the levels of Th1/Th2 cytokine-associated transcription factors and T-lymphocyte clone in peripheral blood mononuclear cells (PBMCs) derived from EP patients, and gene expression level of T-bet/GATA-3 in skin lesion. The potential role of Th1/Th2 reaction pattern played in the pathogenesis of EP was also discussed. Serum levels of IFN-γ, IL-2, IL-4 and IL-10 were quantified by ELISA among 16 EP patients, 20 psoriasis vulgaris (PV) patients and 15 healthy controls. The expression levels of T-bet/GATA-3 in the skin lesion and PBMCs were examined by real-time qPCR. The ratio of Th1/Th2 was measured by flow cytometry. The levels of IFN-γ, IL-2, IL-4 and IL-10 were higher in EP patients than in the healthy controls. The levels of IL-4 and IL-10 were 69.44±11.45 and 12.62±4.57 pg/mL, respectively, in EP patients, significantly higher than those in PV patients and healthy controls (P<0.05). Flow cytometry revealed the levels of both Th1 and Th2 in PBMCs from EP patients were higher than those in healthy controls, and the Th1/Th2 ratio was dramatically lower than in PV patients (P<0.01). The ratios of IFN-γ/IL-4 and T-bet/GATA-3 in EP patients were both less than 1.0, suggesting a reversal when compared with the other two groups. Our study indicated that the EP patients exerted a Th1/Th2 bidirectional response pattern, and the balance of Th cell subsets inclines to Th2, which might be one of the important mechanisms of EP pathogenesis.

Objective To investigate the relationship between urinary iodine level and thyroid disease.Methods The study used a case-control design.One hundred and nine patients with thyroid disease from the Affiliated Hospital of Shanxi Institute for Endemic Disease Control were selected as case group from 2011 to 2012,and these patients were divided into three groups:Graves's disease (GD) group (n =48),chronic lymphocytic thyroiditis (HT) group(n =34) and thyroid nodules group(n =27).Sixty-two healthy people from the same region were selected as a control group.Urinary iodine was determined using arsenic cerium catalytic spectrophotometry,thyroid autoantibody (TRAb) and thyroid peroxidase antibody (TPOAb) was detected using electrochemiluminescence,while iodine absorption rate was measured using thyroid function analyzer,and thyroid volume was measured using type-B ultrasonic method.The relationship between urinary iodine level and patients with thyroid disease was compared with that of control group.Results Urinary iodine levels of patients with GD,HT,thyroid nodules and control groups were 313.95,375.20,220.20 and 196.50 μg/L,respectively.Urinary iodine levels of patients with GD and HT groups were higher than that of control group(Z =3.238,4.275,all P ＜ 0.0125).Urinary iodine level of patients with HT was higher than that of thyroid nodules(Z =3.762,P ＜ 0.0125).Iodine uptakes of GD,HT,thyroid nodules and control groups were (84.20 ± 16.90)％,(23.51 ± 6.72)％,(28.34 ± 8.02)％ and (29.31 ± 8.41)％; TRAbs of patients with GD,HT,thyroid nodules and control groups were (58.57 ± 20.31)％,(2.54± 1.00)％,(2.98 ± 0.83)％ and (3.01 ± 1.21)％; TPOAbs of patients with GD,HT,thyroid nodules and control groups were (117.03 ± 57.21)％,(251.00 ± 98.20)％,(16.81 ± 9.87)％ and (15.00 ± 7.23)％.Iodine uptake,TRAb and TPOAb of GD group were higher than those of control group(P ＜ 0.05).TPOAb of HT group was higher than that of control group(P ＜ 0.05).Urinary iodine levels of GD group and HT group were positively correlated with TPOAb(correlation coefficient were 0.462,0.478 all P ＜ 0.05).Conclusions Excessive iodine intake is found in patients with GD and HT.Determination of urinary iodine is helpful for individualized iodine supplementation.