The glomerular synapses of the substantia gelatinosa in the spinal trigeminal nucleus of the rat were examined by electron microscopy. The central axonal ending in the glomcruli forms asymmetrical axodendritic synapses on adjacent type 1 and type 2 dendrites. Type 2 dendritic spines or shafts (dendrites which contain synaptic vesicles) form dendrodendritic synapses on Type 1 dendritic spine or shafts (dendrites without synaptic vesicles) and also form dendroaxonic synapses on the central ending. The peripheral terminals (P) form symmetrical axoaxonic synapses on the central ending and form axodendritic synapses on the dendrites in the glomeruli.

Objective To explore the diagnosis and treatment of cancerization relative to breast intraductal papilloma. Methods Clinical and pathological data of 52 patients with cancerous change of intraductal papilloma were studied retrospectively from January 1998 to December 2008. Results 39 of the 52 cases were diagnosed as malignance or suspected malignance by at least one of the preoperative imaging examinations such as ultrasonography, breast mammography or ductography. Cancer cells were found in 13 of the 46 patients who received fine needle aspiration. Frozen section established the malignance in 18 of the 39 cases. In a postoperative pathological report, 32 cases were cancerization of intraductal papilloma (carcinoma in situ) and 16 were cancerous change with microinvasion, only 4 patients with invasive carcinoma. All the patients received surgical management, 26 of the 52 cases were treated with modified radical mastectomy, 8 of them were performed with breast-conserving surgery (segmental resection plus axillary lymph node resection),7 cases underwent total mastectomy and 11 were just conducted with segmental resection. Only one people was found with axillary node metastasis among the 34 patients who received axillary lymph node dissection.Conclusion The correct preoperative diagnosis of the carcinomatous change of breast intraductal papilloma are always difficult and inconclusive, the frozen section may be helpful and the final diagnosis relied on the fully drawing materials of pathology after the operation. Treatment should be varied based on different pathological findings.

Transient ischemic attack (TIA) is a high-risk signal of acute ischemic cerebrovascular diseases, indicates a significant increase in the risk of ischemic stroke, especially within 7 days.Risk assessment and stratification are important in patients with TIA.A variety of simple prediction scales were developed based on the risk factors for stroke in patients with TIA, such as the California scale, ABCD scale, and ABCD2 scale.Among them, the ABCD scale score is used most commonly, but as its application becomes more and more common, the defects of this scale are also increasingly apparent.In recent years, some derived scales of ABCD score were introduced in order to improve the sensitivity and specificity of prediction.This article reviews the evolution, contents, characteristics, and predictive value of the ABCD score and its derived scales in the prediction of stroke risk in patients with TIA.

Objective To determine the role of c-Jun N-terminal kinase (JNK) signaling in annulus fibrosus cells response to interleukin (IL)-1. Methods Rat annulus fibrosus cells cultured in monolayer were exposed to IL-1, with or without JNK inhibition by SP600125. RNA was isolated for Real-Time polymerase chain reaction (PCR) after 24 h stimulation. Results IL-1 upregulation of mRNA for inducible nitric oxide synthase (iNOS), IL-6, cyclooxygenase (Cox)-2, matrix metalloproteinase (MMP)-3, MMP-13 were blunted by JNK inhibition, while downregulation of collagenⅠand insulin-like growth factor (IGF)-1 were also reversed by JNK inhibition. Conclusion JNK signaling inhibition can be a therapeutic target for blocking intervertebral disc degeneration induced by IL-1.

Objective To investigate the clinical features,therapeutic approach and prognosis of focal nodular hyperplasia (FNH) of the liver. Methods Clinical data of 34 FNH patients confirmed by operation were analyzed retrospectively. Results Focal nodular hyperplasia of the liver was found mainly in males (67. 6% ) , Mean nodular size was significantly smaller in men than women. Most of the patients (64.7%) had no significant clinical symptoms. Tumor markers including CA19-9 and A-fetoprotein were within normal range. MRI is helpful to achieve a more accurate diagnosis of the disease, correct preoperative diagnosis rate was 54. 5%. All patients underwent liver resection with no recurrence within 17 - 134 months of follow up. Conclusions FHN of the liver is benign in entity. If a definite diagnosis can be obtained preoperatively, observation follow-up are recommended. Hepatectomy is indicated when there is a suspicion of malignancy.

Objective To investigate the clinical features and prognosis of hepatic angiomyolipoma(HAML). Methods Clinical data of 13 patients with operatively confirmed HAML treated in our hospital were retrospectively analyzed. Results HAML was usually asymptomatic and the imaging features varied. Only 1 case was correctly diagnosed before operation. HMB45 positive staining was the pathologic characteristic of HAML. Conclusion HAML can be easily misdiagnosed, should be properly treated by surgery and has a good prognosis.

ObjectiveTo investigate the clinical features,therapeutic approach and prognosis of solitary necrotic nodule of the liver (SNN).MethodsClinical data of 10 SNN patients confirmed by operative pathology were analyzed retrospectively.ResultsSolitary necrotic nodule of the liver was found mainly in males (70.0％,7/10),with a median age of 47 years,most of the patients (80.0％,8/10) have no significant clinical symptoms,no underlying hepatitis.Tumor markers including CA19-9,a-fetoprotein and CEA were within normal range.Nine patients had solitary nodule and 1 patient had multiple nodules.Seven lesions located in left lobe and 4 lesions in right lobe.The diameter of the nodules was 2.9 cm ± 1.1 cm.The lesions were low or iso-intense in T1-weighted MR image,low or slight high intense in T2-weighted MR image.Contrast-enhanced MR imaging showed that internal part of lesions had no enhancement,while the capsule of the lesions demonstrated enhancement.MRI image had high diagnostic accuracy rate of 66.7％.A preoperative liver biopsy was difficult to achieve a definite diagnosis.On microscopic examination,all nodules had a central necrotic core,surrounded by fibrotic cells,inflammatory cells and multinucleated giant cells.Furthermore,among them 5 patients have fatty degeneration of the liver.All patients underwent liver resection with no recurrence within 6 - 67 months of follow up.ConclusionsThe etiology of solitary necrotic nodule is unclear.Misdiagnosis was common due to the low incidence and insufficient recognition among physicians,if a definite diagnosis can be obtained,clinical observation is recommended,and the prognosis is good.

Objective: To investigate the influence of early enteral nutrition (EEN) and PN in postoperative patients with liver tumour.Methods: 120 patients with liver tumour were randomized into 2 groups:EEN+PN group or TPN group. Results: The preoperative condition of two groups was not significantly different. ALB, PA, TBIL and PT were better in EEN+PN group than those in TPN group. The time of gut movement recovery in EEN+PN group was shorter than in TPN patients. Conclusion: Early enteral nutrition combined with PN can improve nutritional state and digestive function recovery in patients with hepatectomy.

Objective To assess the feasibility and indications of local resection as an alternative to pancreaticoduedenectomy for the treatment of early stage ampullary cancer. Methods In this study,36 patients with an AJCC.stage pTl ampullary carcinoma were operated on between 1989 and 2009.Among those local resection was performed in 11 cases and pancreaticoduodenectomy in 25 cases.The main outcome measures were pre-and intra-operative diagnosis and staing,postoperative morbidity and mortality,recurrence.free and overall survival.Results Amp-llary cancerat early stageWas difficult to be diagnosed and staged before and during operation.It was at a much lower risk to perform local resection than pancreaticoduodenectomy.Postoperative complications were significantly lower in local resefion group than in pancreaticoduodenectomy group(P=0.031);whereas the postoperative hospital stay(P=0.254),perioperative mortality(P=1.000).disease-free survival(P=0:301)and long-term survival(P=0.289) were not statistically different between.the two groups. Conclusions Since accurate diagnosis and staginging of early ampullary cancer was diit3cult to establish perioperatively.local resection should be indicated forpoor risk pafients or those who refuse pancreaticoduedenectomy.

Objective To evaluate the efficacy and adverse effect of valproic acid (VPA) in combination with low dose chemotherapy on intermediate and high-risk myelodysplastic syndrome. Methods A total of 41 patients with intermediate (34) and high-risk (7) myelodysplastic syndrome were retrospectively analyzed. Among them, 19 patients received low dose chemotherapy regimen and 22 received low dose chemotherapy plus VPA.Low dose chemotherapy regimen included: homoharringtonine,1-2 mg·m-2·d-1 intravenously,14-28 d; clarubicin,5-7 mg·m-2·-1 intravenously,1-8 d,15-23 d;cytarabine 15 mg/m2 subcutaneously once every 12 h, 14-21 d; and subcutaneously use of granulocyte colony-stimulating factor 200 μg·m-2·d -1 when neutrophil deficiency.The outcome and adverse effect were recorded after the treatment. Results The overall response rate in the low dose chemotherapy regimen group was 47.4% (9/19), 6 patients (31.6%) achieved complete response (CR). The overall response rate in the VPA group was 77.2% (17/22), 9 patients (40.9%) achieved CR. The overall response rate of the low dose chemotherapy in combination with VPA group was significantly higher than that in the low dose chemotherapy group (P＜0.05) while no difference was found in CR rate. The adverse effect of the low dose chemotherapy in combination with VPA regimen was tolerated. Conclusion With acceptable adverse effect, the low dose chemotherapy in combination with VPA regimen is effective for the treatment of intermediate and high-risk myelodysplastic syndrome. Long-term outcome needs further investigation.