Moyamoya disease is a progressive cerebrovascular occlusive disease, which is characterized by the formation of abnormal vascular network at the brain base. It is an important cause of stroke in children and adults. Now, the etiology of moyamoya disease is not clear. This article reviews its pathogenesis from 3 aspects, including genetic factors, angiogenesis, and immune inflammation.

AIM: To establish a HPLC method for determining phenytoin sodium and schisandrin in Compound Valpromide Capsule(Valpromide,phenytoin sodium,Fructus Schisandrae Chinensis, VB_6,etc). METHODS: A Hypersil BDS ODS column was used.The mobile phase was MeOH-0.02 mol/L potassium Dihydrogen Phosphate(60∶40).The detection wavelength was at 254 nm. RESULTS: The linear range of phenytoin sodium was within 4.50 ?g-72.0 ?g(r=1.000 0),The linear range of schisandrin was within 0.024 4 ?g- 0.391 ?g(r=0.999 9).The average recoveries(n=9) were 100.21% and 102.32%,respectively.RSD were 1.3% and 0.5%,respectively. CONCLUSION: The method is simple,reliable,accurate and can be applied to the quality control of the preparation.

BACKGROUND:The clinical research have found that the interbervebral disc herniation often occurs in several members or even al the members of a family, and the location, reason and symptom are basical y the same, indicating that genes play an important role in this kind of disease. OBJECTIVE:To analyze the apoptosis Fas gene expression characteristics of lumbar disc in the familial patients with intervertebral disc herniation. METHODS:Semi-quantitative reverse transcription-PCR was used to test Fas gene expression of vertebral pulp and cartilage endplate in the intervertebral disc among 15 familial patients, 21 ordinary patients and five fresh cadavers. RESULTS AND CONCLUSION:Fas gene expression level of endplate of familial and ordinary patients with intervertebral disc herniation was higher than that of fresh cadavers, and there was no significant difference (P<0.05);there was no significant difference in Fas gene expression in endplates between familial patients and ordinary patients with intervertebral disc herniation (P>0.05). Compared with the vertebral pulps of ordinary patients with intervertebral disc herniation and fresh cadavers, there was no significant difference in the Fas expression of vertebral pulps of familial patients with intervertebral disc herniation (P>0.05). The increasing Fas gene expression may be secondary in the endplates of familial patients with intervertebral disc herniation, which can prevent intervertebral disc degeneration through preventing the endplate degeneration.

AIM:To study the effects of sesamin (Ses) on attenuating renal injury in spontaneously hyperten-sive rats (SHR) and its relationship with PI3K/AKT/mTOR signaling pathway.METHODS:Spontaneously hypertensive rats were randomly divided into 4 groups:model (SHR) group, Ses low-dose (80 mg/kg) group, Ses high-dose (160 mg/kg) group and captopril (30 mg/kg) group.Another 7 WKY rats were given 0.5%sodium carboxymethylcellulose ( CMC-Na, the solvent was used to dissolve the drugs) as control group.Meanwhile, the rats in drug treatment groups were given the corresponding drugs.All animals were administered intragastrically once a day, and the blood pressure was measured every 2 weeks before and after the beginning of the administration.After 12 weeks, blood urea nitrogen ( BUN) , serum creatinine ( SCr ) , urine micro-albumin ( U-mAlb ) , malondialdehyde ( MDA ) and superoxide dismutase ( SOD ) were measured.The pathological changes of the renal tissues were observed under microscope with HE and Masson staining.Ap-optotic rate of nephridial tissue was determined by TUNEL method.The protein levels of p-AKT, p-mTOR, 4EBP1, S6K1, Bcl-2 and Bax were detected by Western blot.RESULTS:Ses decreased the diastolic blood pressure of SHR, significantly ameliorated the pathological damage in the nephridial tissues.Compared with model group, Ses was obviously reduced the contents of SCr, BUN, U-mAlb, MDA and apoptotic rate of the kidney, decreased the protein levels of p-AKT, p-mTOR, 4EBP1, S6K1 and Bax, and increased the protein expression of Bcl-2 and SOD activity.CONCLUSION:The protective effects of Ses against renal injury in SHR may be related to decreasing blood pressure, increasing anti-oxidative stress, re-straining apoptosis and inhibiting over-activated PI3K/AKT/mTOR signaling pathway.

BACKGROUND:Thoracolumbar degenerative kyphosis could experience severe lumbar back pain due to sagittal plane imbalance, thereby affecting quality of life. Thus, it is very important to reconstruct spino-pelvic profile in these patients. OBJECTIVE:To explore the relationships between life quality and spino-pelvic parameters fol owing pedicle subtraction osteotomy for thoracolumbar degenerative kyphosis and the clinical significance. METHODS:Between May 2010 and October 2014, 59 patients with thoracolumbar degenerative kyphosis undergoing L2 pedicle subtraction osteotomy in Cangzhou Hospital of Integrated Traditional and Western Medicine were retrospectively reviewed. Anteroposterior and lateral X-ray films of al patients during standing were photographed before and after surgery. The pre-and post-operative thoracic kyphosis, lumbar lordosis, sagittal imbalance, T1 pelvic angle, pelvic incidence, sacral slope and pelvic tilt were measured in al patients. The patients’ quality of life was evaluated using SF-36 preoperatively and postoperatively. RESULTS AND CONCLUSION:(1) Significant differences were observed in the improvement of thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope and sagittal imbalance (P<0.01). With respect to SF-36, postoperative SF-36 score was higher than preoperative postoperative SF-36 score (P<0.01). (2) The alteration of lumbar lordosis showed significant correlation with the change of pelvic tilt, sacral slope and sagittal imbalance. The change of pelvic tilt exhibited cardinal correlation with the change of sacral slope, body pain and general health. The improvement of sagittal imbalance significantly correlated with the improvement of lumbar lordosis, body pain and general health. The improvement of T1 pelvic angle significantly correlated with the improvement of lumbar lordosis, sagittal imbalance, body pain and general health. (3) Pedicle subtraction osteotomy can effectively restore spino-pelvic sagittal profile, improve the life quality and relieve pain for the patients with thoracolumbar degenerative kyphosis.

Objective To observe the effect of intermediate care on recurrence factors and recurrence rate of elderly patients with cerebral infarction.Methods Five Hundred and ninety-eight cases of acute cerebral stroke were divided into two groups,301 cases in the experimental group and 297 cases in the control group.After the acute stage,patients in the experimental group was included into the intermediate care unit.The experimental group was given comprehensive evaluation and multidisciplinary management,including the combination of traditional Chinese and Western medicine treatment,rehabilitation training and physical therapy,medication guidance,nursing and health education.After the acute stage of the disease,the control group patients were in the general ward.The course of treatment was 2 weeks.At baseline(t0),second weeks(t1),sixth months(t2)and twelfth months(t3),the blood pressure(SBP,DBP),fasting blood-glucose(FBG),blood lipid(TC,TG,LDL),serum homocysteine(Hcy)level and the recurrence rate of cerebral infarction in all two groups were observed.Results SBP at t1,t2 and t3 was lower than that at t0 in the experimental group,and the difference was statistically significant(P＜0.05).SBP in the experimental group at t2 and t3 was lower than that in the control group.There was significant difference between the experimental group and the control group(P＜0.05).DBP at t2 and t3 was lower than that at t0 in the experimental group,and the difference was statistically significant(P＜0.05).DP in the experimental group at t2 and t3 was lower than that in the control group.There was significant difference between the experimental group and the control group(P＜0.05).FBG at t1((5.34±0.76)mmol/L),t2(5.86±1.05)mmol/L)and t3(5.62±0.89)mmol/L)were lower than that at t0((7.27±2.34)mmol/L),and the difference was statistically significant(P＜0.05).FBG in the experimental group at t2 and t3 were lower than that in the control group((6.85±0.92)mmol/L,(6.36±1.03)mmol/L).There was significant difference between two groups(P＜0.05).TC at t1((4.86±0.85)mmol/L),t2((4.21±0.76)mmol/L)and t3((3.95±0.64)mmol/L)were lower than that at t0((5.56±1.06)mmol/L),and the difference was statistically significant(P＜0.05).TC in the experimental group at t2 and t3 was lower than that in the control group((5.06±0.93)mmol/L,(4.84±0.76)mmol/L).There was significant difference between two groups(P＜0.05).TG at t3((1.48±0.26)mmol/L)was lower than that at t0((1.86±1.31)mmol/L),and the difference was statistically significant(P＜0.05).TG in the experimental group at t3 was lower than that in the control group((1.71±0.66)mmol/L).There was significant difference between two groups(P＜0.05).LDL at t1((3.76±0.92)mmol/L),t2((3.09±0.62)mmol/L)and t3((2.59±0.51)mmol/L)were lower than that at t0((4.59±1.45)mmol/L),and the difference was statistically significant(P＜0.05).LDL in the experimental group at t2and t3 was lower than that in the control group((4.09±0.75)mmol/L,(4.12±0.64)mmol/L).There was significant difference between two groups(P＜0.05).Hcy at t1((14.16±3.17)μmol/L),t2((10.37±2.59)μmol/L)and t3((10.10±1.86)μmol/L)were lower than that at t0((23.62±5.62)μmol/L),and the difference was statistically significant(P＜0.05).Hcy in the experimental group at t2and t3 was lower than that in the control group((18.52±3.64)μmol/L,(16.37±2.75)μmol/L).There was significant difference between two groups(P＜0.05).The recurrence rate of cerebral infarction within 1 years was 4.7％(14/301)and 7.1％(21/297)in the experimental group and the control group.There was a decreasing tendency,but no statistical significance(P=0.208).Conclusion The intermediate care may affect the blood pressure,FBG,blood lipids,serum Hcy levels in elderly patients with cerebral infarction,so as to reduce the recurrence rate of cerebral infarction.

Objective To quantitatively assess renal hemodynamic changes in hypertensive acute kidney injury in rabbits induced by L-NAME using 64-slice spiral CT functional imaging techniques,and to explore the application of these techniques in evaluation of early kidney functional changes.Methods Fourteen female New Zealand white rabbits were randomly divided into normal control group (n=6)and L-NAME group (n=8).The control group was injected NaCl solution and the L-NAME group was injected the same amount of L-NAME solution to make hypertensive acute kidney injury model.64-slice spiral CT and SPECT were scanned af-ter injection.Blood samples were collected before and after injecting NaCl and L-NAME solution to detect serum creatinine (Cr).Cr level and CT perfusion parameters of the two groups were analyzed and compared with the pathology results.GFRCT detected by con-trast-enhanced CT and GFRSPECT detected by SPECT were analyzed by the rank correlation test.Results Renal blood volume,blood flow,permeability surface,time to peak,and peak value had statistically significant differences between the control and L-NAME group (P <0.05).GFRCT and GFRSPECT had obvious correlation.GFRCT of L-NAME group was obviously lower than that of the con-trol group.The kidneys of L-NAME group showed obviously injured under both light microscope and microscope.Conclusion 64-slice spiral CT functional imaging techniques can dynamically observe and quantitatively assess early hypertensive kidney dysfunc-tion,especially unilateral renal blood flow abnormalities.It is an effective examination in quantitatively assessing kidney function.

BACKGROUND:MicroRNAs (miRNAs) play an important role in many diseases. To analyze the miRNA expression profile in degenerative scoliosis patients is helpful for classifying its pathogenesis. OBJECTIVE: To compare miRNAs expression profile in the intervertebral disc tissue between degenerative scoliosis patients and healthy controls, and to investigate its role in the pathogenesis of degenerative scoliosis. METHODS:Degenerative nucleus pulposus tissues from 48 patients with degenerative scoliosis (male 36, female 12; 58-69 years old) and normal nucleus pulposus tissues from 36 patients with lumbar fractures were harvested to isolate, culture and identify nucleus pulposus cels folowed by total RNA extract. Differentialy expressed miRNAs were screened by microRNA microarray analysis and validated by real-Time qPCR. Target genes of highly expressed microRNAs were predicted by analyzing information from MicroCosm v5, TargetScan 5.1 and microRNA.org databases. Biological signal pathways associated with the target genes were analyzed, and qPCR was used to validate the screening results. RESULTS AND CONCLUSION:Nineteen differentialy expressed miRNAs were identified. The miR-98 was highly expressed in degenerative nucleus pulposus tissue, and the fold change was 6.368. Predicted miR-98 target gene was interleukin-10, which was involved in JAK-STAT signaling pathway and located in upstream of this pathway. In degenerative nucleus pulposus cels of degenerative scoliosis patients, miR-98 was highly expressed, and the corresponding target gene was interleukin-10. These results indicate that JAK-STAT signaling pathway may play an important role in the pathogenesis of degenerative scoliosis.

BACKGROUND:It has been a hotspot in the treatment of spinal fracture by minimaly invasive approach.Compare with open operation,minimaly invasive surgery has less trauma,less bleeding,less tissue damage and shorter hospital stay.But no clinical study focuses on the reduction effect of minimaly invasive percutaneous screw fixation and maintenance of vertebral height.OBJECTIVE:To compare the difference of minimaly invasive percutaneous screw combined with articular process bone grafting and simple screw fixation in the treatment of thoracolumbar fracture on maintaining vertebral height.METHODS:Clinical data of 79 patients with T11-L2 thoracolumbar fractures (AO type: A1,A2,A3,B1) wereretrospectively analyzed.Among them,41 cases were treated by percutaneous pedicle screw fixation combined with articular process bone grafting,while 38 cases were treated by percutaneous pedicle screw fixation,from January 2010 to September 2013.Perioperative indicators in the two groups,visual analogue scale scores,and Oswestry Disability Index before and after surgery,as wel as at final folow-up were compared between the two groups.The anterior and posterior of vertebral height,the recovery of Cobb's angle were evaluated.RESULTS AND CONCLUSION:The patients in the grafting group were folowed up for 4-36 months and those in the non-grafting group were folowed up for 5-30 months,there was no significant difference in the folow-up time between the two groups (P=0.25).The operation time,intraoperative blood loss,postoperative ambulation time and hospital stay showed no significant difference between the two groups (P＞0.05).The folow-up results showed that,no significant difference was found in visual analogue scale scores and Oswestry Disability Index between the two groups (P＞0.05).However,the anterior and posterior of vertebral height,the recovery of Cobb's angle in the grafting group were significantly better than that in the non-grafting group (P＜ 0.05).The short-term efficacy and security are similar between the two surgery methods in the treatment of thoracolumbar fracture.However,minimaly invasive percutaneous screw combined with articular process bone grafting shows great advantages in recovering and maintaining the long-term stability.

Objective To study the MR imaging characteristics of benign cerebellar astrocytomas(BCAs) in children. Methods The clinical and MR imaging data of twelve patients with BCAs were reviewed and analyzed retrospectively.Results Of 12 tumors, 7 cases were located in the cerebellar hemisphere, 4 in the vermis, and 1 in the IV ventricle. All children were in company with hydrocephalus rated as extensive (n=9) or moderate (n=3). The tumors ranged in diameter from 23 mm to 68 mm, mean diameter 42 mm. Solid tumors were found in 5 children, and cystic areas occurred in 7 of 12 patients.BCAs were hypointense on T 1-weighted in 10 cases, and hyperintense on T 2WI in 9 cases compared with that of normal brain parenchyma. After contrast injection, BCAs marked (n=2), moderate (n=5), or absent (n=5) enhancement. Hemorrhage and calcification were not common (n=1,0, respectively).Conclusion BCAs has relative characteristic features on MRI in children, and MRI plays an important role in diagnosing and evaluating these tumors preoperatively.