Objective To summarize the diagnosis and surgical therapeutic experience of insulinoma.Methods The clinical data of 130 patients with insulinoma confirmed by pathologic examination from 1966 to 2008 were analyzed retrospectively.Results All the patients had Whipple's triad.37.7％ were once misdiagnosed.Only 43.8 ％ were diagnosed correctly within one year after the onset of symptoms.The average time of evolution was 5.2 years.Ultrasonography,CT,MRI and ASVS were able to localize tumor in 32.9％,70.6％,70.3％ and 88.9％ of the cases,respectively.There were 121 cases (93.1％) of single insulinoma,4 cases (3.1％)of multiple insulinomas,and 5 cases(3.8％)of hyperplasia.127cases(97.7 ％)were benign and 3 cases (2.3 ％)were malignant insulinoma.All the 130 cases underwent surgery,among whom 89 cases were cured by enucleation of tumor.The principal postoperative complications were pancreatic fistula(19.2％) and pancreatitis(3.9％).Conclusions Whipple's triad was with great significance to diagnose insulinoma.Multislice spiral CT is the first choice for preoperative localization of insulinoma and ASVS is an important complementary measure for localizing insulinomas not detected by CT or MRI.Simple enucleation is the most common surgical method.

Objective To evaluate the clinical value of selective intra-arterial calcium stimulated venous sampling ( ASVS) for the localization of pancreatic insulinoma preoperatively.Methods The clinical data of 28 insulinoma patients admitted from May 2000 to June 2010 in Ruijin Hospital undergoing selective intra-arterial calcium stimulated venous sampling with diagnosis of insulinomas before surgery were analyzed retrospectively.Results There were 12 males and 16 females.All the patients had Whipple's triad, and with proved insulinomas by postoperative pathology.There were 26 cases of single insulinoma and 2 cases of multiple insulinomas with altogether 32 insulinomas resected.78.1% of insulinomas were less than 20 mm.All patient were examined by selective intra-arterial calcium stimulated venous sampling.The peak ratio of insulin to the baseline after calcium stimulation appeared at the superior mensenteric artery (SMA) in 6 cases, and the peak ratio of insulin to the baseline after calcium stimulation appeared at gastroduodenal artery(GDA), proximal splenic artery (SAP) and distal splenic artery (SAD) in 9 cases, 6 cases and 6 cases respectively; Selective intra-arterial calcium stimulated venous sampling accurately located 25 cases, and selective intra-arterial calcium stimulated venous sampling located 2 cases wrongly.In one patient, the selective intra-arterial calcium stimulated venous sampling was falsely negative.The mean and median peak ratio of insulin to the baseline after calcium stimulation were 8.8 folds and 14.8 folds respectively.Accurate rate of selective intra-arterial calcium stimulated venous sampling was 89.3% (25/28) and it was higher than that of computed tomography (CT) (56.5% ) , magnetic resonance imaging (MRI) (60.0%).Sensitivity of selective intra-arterial calcium stimulated venous sampling was 96.2%, which was higher than that of computed tomography ( 69.6% ) , magnetic resonance imaging (75.0% ).Conclusion Selective intra-arterial calcium stimulated venous sampling is superior to computed tomography, or magnetic resonance imaging as a preoperative localizing tool for insulinomas, since this procedure is invasive it should be used when other preoperative morphologic studies (computed tomography or magnetic resonance imaging) failed.

Novel optical materials are crucial for environmental monitoring. Metal nanoclusters ( metal NCs) , typically consisting of several to tens of metal atoms, have attracted more and more attention for recent years. Due to their ultrasmall size, strong fluorescence, low toxicity, excellent stability and unique core-shell structure, metal NCs have been considered as promising optical materials for the construction of excellent fluorescent sensors. In this review, we mainly focus on the recent progress in their applications in environmental monitoring, including the detection of pH, heavy metal ions, inorganic anions and nitroaromatic explosives.

Objective:To analyze the curative effect of suppression expression of URG4 on cervical cancer mice and the possible mechanisms.Methods:The expression of URG4 were analyzed in cervical cancer tissues and para-carcinoma tissues.16 male BALB/c nude mice were divided into Group A ( inoculated with URG4-siRNA SiHa cells) and Group B ( inoculated with SiHa cells) . After 4 weeks,mice were executed and analyzed.Results:The expression of URG4 were higher in human cervical cancer tissues than that in para-carcinoma tissues ( P<0.05).After experiment,Group A had a lower tumor weight,but a higher body weight than these of Group B,the difference was statistically significant (P<0.05).Group A mice had a lower levels of URG4 in tumor than that of Group B mice (P<0.05).Group A mice had a lower levels of Ki67 in tumor than that of Group B mice,the difference was statistically significant (P<0.05).Group A mice had lower levels of CyclinD1,β-catenin and C-myc in tumor than these of Group B mice (P<0.05). Conclusion:The expression of URG4 in cervical cancer tissue is up-regulation.Suppression expression of URG4 can suppress tumor growth in vivo,which may though suppress the Wnt/β-catenin signaling pathway.

Objective To study whether the viral metabolites can make influence on biological behavior of mesenchymal stem cells (MSCs) and to provide evidence for safe MSCs transplantation.Methods MSCs were isolated from bone marrow of C57BL/6 mice and the mRNA level of Toll like receptor 3 (TLR3)was detected.In vitro polyinosinic-polycytidylic acid [poly(I ∶ C)] was used as the product of viral metabolite to stimulate MSCs.We recorded the change of MSCs in terms of self-renewal,multi-directional differentiation,directional migration and immunosuppression by flow cytometry,PCR etc.Results ①Low-expressed TLR3 mRNA was dectected in MSCs and it was upregulated after being stimulated by poly(I ∶ C).②After being stimulated by poly(I ∶ C)for 24,48,and 72 hours,the self-renewal ability of MSCs had no statistical difference with that of the control group(P ＞0.05).However,poly (I ∶ C)promoted the differentiation of MSCs to lipoblast and osteoblast (P ＜ 0.01).③The directional migration ability of MSCs was weakened significantly by poly(I ∶ C) stimulation.After being stimulated for 6,12,and 24 hours,the migration rate of MSCs was(82.83 ± 1.69) ％,(87.80 ± 3.58) ％,and (92.67 ± 2.52) ％ respectively compared to that of the control group.The difference had statistical significance(P ＜0.01).④MSCs had great immunological suppression ability and it was dependant on the number of MSCs.After being stimulated by poly(I ∶ C),the ability of MSCs' immunological suppression on proliferation of activated splenocytes was not impaired and the difference had no statistical significance compared with that of the control group(P ＞0.05).Conclusion While maintaining the viability and immunosuppression function of MSCs,viral metabolite inhibits migration of MSCs,holds them in the transplanted position and protects the graft,providing evidence for MSCs as seed cells in the treatment of diabetes and other immune disorder diseases.

Objective To study the protection of mouse bone marrow-derived mesenchymal stem cells ( MSCs) for allogenic islets. Method MSCs from C57BL/6 mice were preceded to a 24-well culture plate with the density of 3 × 104/well. On the second day, islets were isolated, purified and divided to undergo streptozotocin (STZ) induced chemical injury and mixed lymphocyte reaction ( MLR) respectively. Then, treated and control islets were respectively divided into the following groups: islets + MSCs, STZ-islets + MSCs, and MLR-islets + MSCs. As control groups for their counterparts, treated or non-treated islets were also cultured without MSCs. On the 5th day incubation, glucose-stimulated insulin secretion test was performed to assess the function of islets in different groups, comparing their insulin-secretion amount stimulated by low or high glucose and the stimulation index determined by the ratio of (insulin amount secreted under high-glucose stimulation)/(insulin amount secreted under low-glucose stimulation ). Islet viability was evaluated by acridine orange (AO)/propidium iodide (PI) fluorescence staining. Result As shown by AO/PI staining, large numbers of dead cell with red fluorescence could be observed in STZ- or MLR- treated islets without MSCs, while the number of dead cells obviously reduced in MSC-cocultured islets with increased viable cells of green fluorescence. STZ- or MLR- treated islets exhibited apparently decreased insulin-secretion amount either under low- or high-glucose stimulation, as well as the stimulation index. The insulin-secretion function was significantly improved in islets cocultured with allogenic MSCs (P ＜ 0. 05 ). Conclusions Bone marrow-derived MSCs can protect isolated allogenic islets against chemical and immunological injury.

0.05). Conclusion When TOFR recovers to 0.55,antagonism of residual neuromuscular blockade is still necessary.Different doses of neostigmine may antagonize vecuronium-induced residual neuromuscular blockade,and lower dose of neostigmine(10-20 ?g/kg) is recommended.

Objective To describe the clinical manifestation of the chronic atlantoaxial rotatory dislocation (AARD) with C1,2 lateral facets locked,and explore the effect of the operation combined with anterior retropharyngeal approach and posterior approach.Methods Data of 8 patients with chronic AARD with C1,2 lateral facet locked who had undergone open reduction with the anterior retropharyngeal approach and C 1,2 transpedicular screw fixation with autologous iliac bone graft from Oct.2010 to Jun.2013 were retrospectively analyzed.There were 4 males and 4 females with an average age of 31 years old (range,11-57 years old).The intervals from onset to diagnosis were from 29 to 180 days and the mean time was 70.6 days.5 cases were chronic AARD with right C1,2 lateral facets locked and 3 with left C1,2 lateral facets locked.Reduction was failed to obtain by traction for two to four weeks.Subsequently,after open reduction with the anterior retropharyngeal approach,the patients were performed C 1,2 transpedicular screw fixation with autologous iliac bone graft for one stage or two.Results 1 patient underwent open reduction with the anterior retropharyngeal approach in stage one and C1,2 transpedicular screw fixation in stage two because of an overall severe condition,and the other patients did anterior and posterior operation in one stage.The average operation time was 205 min (range,160-260 min).The mean blood loss was 210 ml (range,100-300 ml).There were no operation complications except one young girl reflected pain in autologous iliac donated area,and pain relieved when taking non-steroidal anti-inflammatory by oral for one week.All patients had been followed up for a mean period of 14.8 months (range,5-37 months).Three-dimensional computed tomography revealed C1,2 arthrodesis bone graft fusion from two to four months and the average was 3.1 months.Neither recurrence of symptoms nor dislocation was observed at the latest follow-up.Conclusion Open reduction through the anterior retropharyngeal approach with C1,2 transpedicular screw fixation is an effective treatment strategy for chronical AARD with C1,2 lateral facets locked,which reduces surgical complications with less operation difficulty.

Objective To clarify the diagnostic value of salivary gland ultrasonography in Sj(o)gren's syndrome (SS),and its correlation with the disease activity index and important organs involvement were analyzed.Methods A total of 116 patients with SS were involved,including 71 cases of primary SS and 45cases of secondary SS.Ultrasonography examination of major salivary glands was conducted for these patients,at the same time the clinical data including inflammatory parameters,the immunological parameter and the involved systems were collected.Ultrasonography examination was conducted in 49 cases as the control group.Use t test,x2test and analysis of variance for statistical analysis.Results The positive rate of salivary gland uhrasonography in SS (56/116,48.3％) was significantly higher than that of the normal control groups (1/49,2.0％),(The chi-square value was 32.57,P＜0.05),the sensitivity of salivary gland ultrasonography in primary SS (62.0％) was obviously higher than secondary SS (27％),(The Chi-square value was 13.75,P＜0.01).The specificity of salivary gland ultrasonography was 98％.The scores of salivary gland ultrasonography had shown positive correlation with the erythrocyte sedimentation rate,the levels of Immunoglobulin (Ig)G,and RF(r=0.234,0.353,0.176;P=0.002,0.000,0.013),and negative correlation with the white blood cell count (r=-0.292,P=0.000).Conclusion Salivary gland ultra-sonography provides additional evidence for the diagnosis of SS,particularly in primary SS groups.The scores of ultrasonography are correlated with inflammatory biomarkers,indicating that salivary gland ultrasonography is related to disease activity.

Objective To provide reference for improving the performance of public health by establishing performance evaluation framework of public health in rural areas of China.Methods The performance evaluation framework of public health in rural areas is established by literature research,theoretical derivation and Delphi method.The results of expert consultation are tested by W test of Kendall coordination coefficient and chi-square test.Results The performance evaluation framework of public health in rural areas contains four conceptual modules,ten performance goals and twenty-eight performance evaluation indexes.The positive coefficient of experts is 0.889.The average values of authoritative grade of experts are between 0.681～0.715.The Kendall W uniformity coefficients of the necessity,sensitivity and maneuverability of the indexes are respectively 0.167,0.209 and 0.185.The P values are less than 0.01.Conclusion The performance evaluation framework of public health in rural areas has certain application value.It is necessary to pay attention to scientific nature and applicability in developing performance evaluation of public health in rural areas.