ObjectiveTo analyze the clinical features of tertiary hyperparathyroidism. MethodsThe data including symptoms, past history, bone and joint X-ray, bone mass density, bone SPECT, blood routine, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone ( PTH), as well as parathyroid ultrasonic or CT,parathyroid ECT, and parathyroid pathology were collected from seven patients with tertiary hyperparathyroidism.ResultsThe first symptom in 6 patients was bone ache, one of them was thirsty, and 1 patient had fracture. Four patients had past history of gallbladder stone or renal stone. Four subjects presented with osteoporosis and 2 of them had fractures. All 7 patients suffered from hypercalcaemia, along with high PTH level, 6 with hypophosphataemia and 6 with high alkaline phosphatase level. The enlarged parathyroid glands were detected in five patients by ultrasonic or CT. Tc99 scans of parathyroid gland revealed hyperfunctioning nodes in 3 subjects. Six patients were operated, and pathological results showed adenoma in parathyroid gland in 5 patients and adenocarcinoma in 1 patient. Serum calcium and PTH levels returned to normal in all the operated patients.ConclusionsPatients who present bone ache, osteoporosis, spontaneous fracture, past history of gallbladder stone or renal stone, high serum calcium, and PTH levels, should be aware of the probability of tertiary hyperparathyroidism. The confirmed diagnosis depends on pathological result.

AIM:To establish an HPLC method for determining cinnamaldehyde,costunolide and dehydrocostuslactone in the supercritical carbon dioxide extraction of Cinnamomum cassia and Aucklandia lapp.METHODS:The assay was performed on an Agilent HC-C_(18)(150 mm×4.6 mm,5 μm)column by UV detector at the wavelength of 210 nm with acetonitrile-water(gradient elutio)as the mobile phase at the flow rate of 1.0 mL/min,and the column temperature was 30℃.RESULTS:There were good relationships between peak area and sample size of cinnamaldehyde in the range of 148.5-1 732.5 ng,between peak area and sample size of costunolide in the range of 69.42-809.9 ng,and between peak area and sample size of dehydrocostuslactone in the range of 70.32 to 820.4 ng.Average recoveries of them were in turn 99.65%(RSD 0.72%)-99.57%(RSD 1.28%),and 98.90%(RSD 0.81%),respectively.CONCLUSION:The present method is convenient,sensitive and accurate with good reproducibility and can be used for the quality control of the supercritical CO_2 extract of Cinnamomum cassia and Aucklandia lapp.

BACKGROUND:Studies have shown that placement, needling point, angle and length of pedicle screws for thoracic vertebral fractures have been unified. Many studies concerned axial pul-out force and biomechanical behavior of a single screw, but few reports addressed the biomechanical behavior after the replacement with three kinds of screw connecting to rods. OBJECTIVE:To further observe and compare biomechanical behavior after three kinds of thoracic screw placement connecting rod using biomechanical testing, to understand the strength of thoracic pedicle screw replacement connecting rods, and the effects of its puling out on the stress of the bone surrounding the placement site. METHODS:The fresh frozen specimens of thoracic vertebra were divided into three groups at random: the pedicle fixation group, the transverse process-vertebral body fixation group, and modified rib transverse process fixation group. Thoracic pedicle screw system was inserted by the standard placement method in each group. The experiment was measured on the mechanical equipment. During puling out, the strength that bone bore was described with dynamic curve, folowed by statistical analysis. The difference in the gripping force on the thoracic vertebra among three kinds of screw placement method was compared. RESULTS AND CONCLUSION: Among three kinds of screw placement methods and among three kinds of screw placement methods on the injured vertebral body, the gripping force was significantly bigger in the pedicle fixation group than in the transverse process-vertebral body fixation group and modified rib transverse process fixation group (P < 0.01). No significant difference in the gripping force was detected between the transverse process-vertebral body fixation group and modified rib transverse process fixation group. Results verified that the stability of loading ability was apparently better in the pedicle fixation group compared with the transverse process-vertebral body fixation group and modified rib transverse process fixation group.

Objective To discuss the mechanism of obesity related glomerularpathology,we detect the expression of Podocin in glomerular podocytes of obesity rats induced by high fat diet.Methods The rats were divided into 2 groups:normal control group(Con group) and obesity group(Ob group).At the 14th week of molding,the body weight,body long,tail long,kidney weight,uria microalbumin,RBP,uria Cre,blood glucose,cholesterol,triglyceride,HDL-C,UA,Cre,BUN,and insulin were measured.The Lee's index,insulin resistance index,insulin sensitive index,Ccr and relative kidney weight were calculated.The tissue structures of the kidney of both groups were studied under light microscope and transmission electro microscope.The expression of Podocin in podocyte of rats' kidney was measured by immunohistochemistry and western blot.Results ①The difference had no statistical significance between the 2 groups in gender,weight,body length,tail length and Lee's index at the beginning (P ＞ 0.05).But after 14 weeks,the weight,body length and Lee's index of Ob group were significantly higher than those of Con group(P ＜0.05).②At the 14th week,the fasting plasma glucose of Ob group was higher than that of Con group (P ＜ 0.05),and the high density lipoproteins (HDL) of Ob group was lower than that of Con group(P ＜ 0.05).However,the difference had no statistical significance in urine acid (UA),serum Cre and blood urea nitrogen (BUN) between the 2 groups (P ＞ 0.05).③The urine protein and endogenous creatinine clearance rate(Ccr) in Ob group were higher than those of Con group (P ＜ 0.05,P ＜0.01).④The relative kidney weight of Ob group was lower than that of Con group(P ＜ 0.05).⑤For rats in Ob group,glomerular hypertrophy,the Bowman' capsule stricture,abnormality in the segmental capillary wall and extraglomerular mesangial cell were observed under light microscope.The glomerular podocytes became broader and foot process of podocyte in Ob group became microvillus-like in Ob group under transmission electro microscope.⑥Immunohistochemistry and western blot showed that the expression of Podocin in podocyte of kidney decreased in Ob group.Conclusions The expression of Podocin decreased in podocyte of kidney in obesity rats.At the same time,the ultrastructure of podocytes was changed.Those may be one of the reasons for protein urine related to obesity.

Objective Using Mental Practice as a training method to train students grasping skills of minimally invasive surgery(MIS),and analyze the change of mental practice in training grasping skills of MIS.Methods 36 students were randomly divided into mental practice training group (MPTG) ( n =12 ),conventional training group (CTG) ( n=12),control group (CG) ( n=11 ).Under the uniform appraisal standards and conditions,using different training methods to teach the grasping skills of MIS,and analyze the results statistically.Results MPTG' s pre-training test results ( 16.18 ± 5.73 ) and post-training test results (79.47 ± 22.05 ) were significantly different(P ＜ 0.001 ),post-training and two weeks later test results ( 89.32 ± 31.56) displayed no significant difference(P=0.283) ; CTG' s pre-training test results ( 17.47 ±8.33) and post-training test results (57.18± 21.83 ) were significantly different (P ＜ 0.001 ),post-training and two weeks later test results (42.27 ± 24.64)had significant difference(P=0.048) ; CG's pre-training test results ( 18.19 ± 4.74) and post-training test results (38.04 ± 19.13 ) were significantly different(P =0.003 ),post-training and two weeks later test results (23.71 ±15.71 ) had significant difference (P=0.034).Compared with MPTG in pre-training test,CTG (P=0.632) and CG (P =0.464) neither had significant difference,but in the post-training test,CTG (P =0.014) and CG (P ＜0.001 ) both had significant difference compared with MPTG.In the two weeks later test,CTG and CG both (P＜0.001 ) had significant difference compared with MPTG.Conclusion Mental practice training method can improve the pedormance of gasping skills of MIS significantly and better durability,improve the learning curve,easy to implement in teaching,easy to master students,it will be a new method of MIS skills training in the future.

Objective To study dose-response relationship and screen the optimized fractionated irradiation schedules in subclinical tumors of malignant glioma.Methods Balb/c-nude mice bearing human malignant glioma xenograft were assigned randomly into control group,fractionated irradiation schedules group and nimotuzumab-conventional fraction group.The fractionated schedules were 200 cGy x 5f/w,300 cGy ×5f/w,160 cGy ×2f/d x5 d and 400 cGy ×3f/w with total dose of 40 Gy and 60 Gy,respectively.Measurement indexes were tumor-forming rate,average recurrence time and maximum diameter of the tumor bottom.The observation lasted 24 weeks.Results With the total dose of 40 Gy,none of the significant long-term tumor regression were detected in any fractionated irradiation schedules; 400 cGy x 3f/w with complete tumor response at the end of treatment showed a better short-term curative effect.With the total dose of 60 Gy,long-term control rate of each fractionated irradiation schedule group was improved with prolonged average recurrence time of varable degrees,except 200 cGy x 5f/w fractionated schedule (tumor formation rate was 100％ at the end of treatment and average recurrence time was the poorest of 108 d).160 cGy × 2f/d × 5 d fractionated schedule showed the best curative effect with no tumor formation in 2 of 8 mice and longest recurrence time of 143 d.300 cGy x 5f/w fractionated schedule ranked second with no tumor formation in 1 of 8 mice and average recurrence time was 137 d.400 cGy x 3f/w fractionated schedule produced the poorest outcome with no case cured.There were no significant changes in the tumor-forming rate or average recurrence time when nimotuzumab was concurrently used for subclinical tumors of malignant glioma with total dose of 60 Gy.Conclusions Conventional fractionated irradiation is not the best option to control the sustained growth.160 cGy ×2f/d ×5 d and 300 cGy × 5f/w might be the optimized fractionated irradiation schedules for subclinical tumors of malignant glioma.

BACKGROUND:Compared with bone marrow and autologous peripheral blood stem cells, umbilical cord mesenchymal stem cells are characterized as more primitive, more powerful amplification and lower immunogenicity, no ethical problems, which are more important to the elderly patients with diabetes mel itus. OBJECTIVE:To evaluate the efficacy and safety of umbilical cord mesenchymal stem cells transplantation in the treatment of the elderly patients with diabetic lower limb vascular disease. METHODS:Fifty-six elderly patients with diabetic lower limb vascular disease were randomly divided into observation group and control group. The control group was treated with conventional therapy, while the observation group was treated with umbilical cord mesenchymal stem cells transplantation. RESULTS AND CONCLUSION:Observation group showed a higher efficiency than the control group, with significant difference (P<0.05). After treatment, foot skin temperature, transcutaneous oxygen pressure, and ankle brachial index were al improved in both two groups, and the ankle brachial index showed a better value in the observation group (P<0.05). There were no significant adverse reactions in the two groups. Umbilical cord mesenchymal stem cells transplantation is a simple, safe and effective therapy for the elderly patients with diabetic lower limb vascular disease, with better short-term curative effect.

Objective To impmve the method of "modified comet assay" in predicting the radiosensitivitv of solid tumor. Methods A single cell suspension from biopsy sample was lmdlated on ice with a dose of 5 Gy.The microscope slide was spread with agarose,lysed for 50 minutes,rinsed 3 times rinse solution,and given electrophoresis for 20 minutes. After being stained with PI,cell images were collected through the microscope and analyzed with Lucia G software(Version 4.6).In order to check system/ background errors,every sample was made into control slide and irradiation slide.The end-points were cell DNA contents and tail moment. Results The factors influencing the results included:(1)Sample was iaulty tor the biopsv taken from mucosa and no tumor cells were contained. (2)The slides with a high backgmund ( induced by necrosis) disturbed the measurement of comet assay. (3) Setting lymphocytes as control to check svstem errors was very important. (4)To separately collect images of the normal tissue cells and tumor cells from the biopsy sample improved the conformity between the clinical obscrvation and the lab result. Conclusions To increase the correlation between comet assay and clinical response,it is very helpful to set double control for checking system/background errors and to collect images of the normal tissue cells and tumor cells through the microscope,respectively.

Magnetic resonance imaging (MRI) simulator (MRI-Sim) can provide superior images for radiotherapy.Due to the complexity of MRI technology and the safety problem caused by strong magnetic field, the acquisition and implementation of MRI simulation is more complicated than CT simulation.In order to ensure the introduction of MRI-Sim, this paper reviews the selection, installation, and acceptance test of MRI-Sim, including the selection of host and auxiliary equipment, installation site preparation, and safety precautions,as well as MRI-Sim acceptance test and commissioning.

Objective To evaluate the effect of sevoflurane on the expression of aquaporin 8 (AQP8) in the intestinal mucosa in a pig model of hemorrhagic shock.Methods Twenty-four Bama miniature pigs of both sexes, weighing 22-25 kg, were randomly divided into 3 equal groups using a random number table: sham operation group (group S), hemorrhagic shock group (group HS) and sevoflurane group (group PS).The femoral artery and jugular vein were cannulated for blood pressure monitoring, blood-letting, and blood sampling in anesthetized pigs.Hemorrhagic shock was induced by withdrawing blood from the right femoral artery.Hemorrhagic shock was induced after cannulation in group HS.In group PS, 2％ sevoflurane was inhaled for 30 min after the model of hemorrhagic shock was successfully established.Before anesthesia, and at 0.5, 1, 1.5, 2, 3 and 4 h after hemorrhagic shock, blood samples were collected from the jugular vein for determination of serum D-lactic acid and intestinal fatty acid-binding protein (I-FABP) concentrations.The animals were sacrificed at 4 h after hemorrhagic shock, and the intestinal specimens were obtained for microscopic examination and for determination of AQP8 expression in the intestinal mucosa (by enzyme-linked immunosorbent assay).The intestinal water content was calculated.Results Compared with group S, the serum D-lactic acid and I-FABP concentrations, AQP8 expression, and intestinal water content were significantly increased in HS and PS groups (P＜0.05).Compared with group HS, the serum D-lactic acid and I-FABP concentrations, AQP8 expression, and intestinal water content were significantly decreased in group PS (P＜0.05).The pathological changes of intestinal tissues were significantly reduced in group PS as compared with group HS.Conclusion Sevoflurane can decrease the intestinal mucosal edema through inhibiting AQP8 expression, thus reducing hemorrhagic shockinduced damage to the intestinal mucosa in pigs.