Adult ; Antihypertensive Agents ; therapeutic use ; Blood Pressure ; drug effects ; Depression ; complications ; drug therapy ; physiopathology ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Hypertension ; complications ; drug therapy ; physiopathology ; Male ; Middle Aged ; Phytotherapy ; Powders ; Treatment Outcome

Background Toll-like receptor 4 (TLR4) is an immune related receptor.It plays an important role in inducing inflammation response.The inflammatory response secondary to optic nerve crush will results in serious retinal damage.It is worthy of studying the expression and effect of TLR4 in retina after optic nerve crush.Objective This experimental study was to explore the role of TLR4 in the loss of retinal ganglion cells(RGCs) after optic nerve crush.Methods Twenty-four SPF adult health Sprague-Dawley (SD) rats were used in the study and radomized into two groups based to the experimental time.The optical nerve crush models were established by crushing the optical nerve in the right eyes of the rats,and the left normal eyes served as controls.The rats were sacrificed by over anesthesia and retinas were isolated 3 days and 7 days after operation.Expression of TLR4 in the retinas was detected using immunofluorescence method.Reverse trancription PCR (RT-PCR) and Western blot were applied respectively for the detection of TLR4 mRNA and protein in the retinas.The apoptosis of RGCs was evaluated using TUNEL staining.The use and care of experimental animals followed theGuide for the Care and Use of Laboratory Animals of NIH.This study was approved by the Institutional Animal Care and Use Committee at the Zhongshan Ophthalmic Center.Results The expression of TLR4 in rat retinas presented with green fluorescence mainly in the inner layer of retinas.The fluorescence was enhanced in the model 3 days group and the model 7 days group compared with the corresponding control groups.The relative expressing values of TLR4 mRNA in the retinas were 2.92±0.06and 3.92±0.12 in the model 3 days and 7 days groups,respectively,which were significantly higher than 2.87±0.12and 3.44±0.17 in the control 3 days and 7 days group (t3d =-12.888,P＜0.001 ;t7d =-4.669,P=0.010).In the model 3 days group and model 7 days group,the grey values of TLR4 protein were 1.14±0.05 and 1.49±0.03,and those in the control 3 days and 7 days groups were 0.99 ± 0.09 and 1.38 ± 0.07,showing significant differences between them(t3d =-11.324,P＜0.001 ;t7d =-5.638,P=0.005).Apoptotic RGCs were obviously increased in the optic nerve damage group in comparison with the control group.Conclusions The TLR4 is over-expressed in the inner layer of retina after optic nerve crush,which suggestes that TLR4 is probably involved in the loss of RGCs after optic nerve crush.

Objective To identify the correlation factors associated with cerebral intragenic ischemia after temporary parent arterial occlusion in intracranial aneurysm surgery. Methods One hundred and eighteen patients who underwent temporary arterial occlusion in the 120 aneurysms (from a group of 324 consecutive aneurysm patients treated from 1996 to 2002) were reviewed retrospectively. These variables included sex, age, presence of preoperative subarachnoid hemorrhage (SAH), neurological clinical grade, operational timing, duration of arterial occlusion, numbers of temporary occlusion, mode of arterial occlusion, intraoperative aneurysm rupture, hypertension, the location of temporary occlusion, aneurysm size, hyperglycemia, atheromatous mass. Univariate and multivariate were used to investigate the relationship between the variates and postoperative ischemic changes. Results The total times of temporary occlusion were 156, with an average of 1.30. The duration of arterial occlusion ranged from 1 to 45 min (9.75?7.75). Seventeen patients (14.4%) demonstrated evidence of new infarction in the vascular territory subjected to temporary arterial occlusion. Conclusion In the univariate analysis, age, presence of preoperative SAH, duration of arterial occlusion, atheromatous mass are all significantly correlated with postoperative ischemic injuries. Multivariate logistic regression revealed that the age, older more than 60 (P= 0.010 3 , relative risk=4.335), and the duration of arterial occlusion, lasting more than 20 min (P= 0.032 9 , relative risk=4.177), have significant correlation with the injuries. Based on these findings, temporary occlusion is safe and useful in aneurysm surgery and the postoperative cerebral ischemia is less likely to occur when the duration of clipping is shorter than 20 min.

Considering the present condition of nuclear medicine experiment teaching and management model,this paper proposes some reform measures:reforming teaching model,adjusting teaching content,enhancing lab management.

ObjectiveTo evaluate the clinical and functional outcome of traumatic segmental defects of the tibia treated by internal bone transport using the the adjustable mono-lateral external fixation.Methods12 patients who underwent internal bone transport using the the adjustable mono-lateral external fixation for traumatic segmental defects in the tibia were reviewed, the length of bone defect was 6～10 cm.ResultsMean follow-up was 14 months. All the cases got primary bone union. The length of time in healing was 9～14 months.ConclusionTraumatic segmental defects of the tibia treated by internal bone transport using the adjustable mono-lateral external fixation is a simple, less traumatic, non-bone graft and effective way.

Objective:To investigate the expression of TIP30 and its relationship with clinico-pathological characteristics in patients with extrahepatic cholangiocarcinoma (ECC).Methods:The expression of TIP30 in 78 cases of ECC tissues and 78 cases of para-cancerous tissues were detected by immunohistochemistry.Results:The positive expression rate of TIP30 was 43.59％ and 75.64％ in ECC tissues and para-cancerous tissues,respectively.Differences were statistically significant (P＜ 0.05).The expression levels of TIP30 were not correlated with age,gender,degree of differentiation and tumor size(P＞0.05),but correlated with lymph node metastasis,distant metastasis and TNM staging(P＜ 0.05).The median overall survival of 78 ECC cases was 14.8 months,and it of TIP30 positive expression cases was 20.3 months,statistically higher than 11.5 months in TIP30 negative expression cases(P＜ 0.01).Conclusion:The downregulation of TIP30 is closely correlated with the development,metastasis and prognosis of ECC.TIP30 may be used as a molecular marker to identify and predict the progression,metastasis and prognosis of ECC.

This paper analyzed and discussed on the importance of doctor-patient communica-tion skills and the differences between foreign countries and China. Meanwhile, it pointed out the drawbacks of doctor-patient communication skills training for medical students in China and proposed some countermeasures including finding out influence factors, searching for reference books, provid-ing guide for doctor-patient communication theory and skills, formulating teaching pattern, building evaluation mechanism, and establishing a communication platform of doctor-patient communication skills for medical students.

[Abstract ] Objective At present, the majority of injectable tissue engineering bones or carrier stents are gel , whose surface area , intensity, and hardness cannot satisfy the requirements of the repair of complex and varied bone and cartilage defects .This paper evaluated the new injectable microspherical porous chitosan/biological properties of the hydroxyapatite ceramic scaffold . Methods Injectable porous chitosan /hydroxyapatite composite microspheres with mass fractions of 30%, 50%, and 70% were prepared respectively . The hydroxyapatite ceramic ball was obtained by sintering with liquid nitrogen freezing ( liquid nitrogen group ) or without liquid nitrogen pro-cessing ( non-liquid nitrogen group ) as a new carrier of bone tissue engineering scaffold material .The microstructure of the scaffold was observed and the porosity measured under the scanning electron microscope .The mechanical properties were determined through biome-chanical experiments.Human umbilical vein endothelial cells (HUVECs) were grown in the porous chitosan/hydroxyapatite ceramic scaf-fold followed by observation of the growth of the cells and validation of the biological fusion of the scaffold . Results No difference was observed with the naked eye in the ceramic scaffold of different mass fractions in the liquid nitrogen and non -liquid nitrogen groups . Scanning electron microscopy exhibited spherical shape , uniform size, and regular morphology of the ceramic scaffolds in both groups .A large number of irregular pores were seen in the surface of the microspherical ceramic scaffolds treated with liquid nitrogen but not in the surface of those not treated .With increased mass percentage of chitosan/hydroxyapatite , the internal pores were reduced and the interior structure compacted.In the liquid nitrogen group, the scaffold of 50%mass fraction had a significantly larger diameter ([0.48 ±0.11] mm), higher compression intensity ([1.75 ±0.14] MPa), and lower porosity ([79 ±2]%) than that of 30%mass fraction ([0.40 ± 0.08] mm, [1.21 ±0.12] MPa, and [87 ±1]%) (all P<0.05).Electron microscope scanning revealed well -grown HUVECs with multiple synapses in the porous tricalcium phosphate scaffold. C onclusion The porous chitosan /hydroxyapatite ceramic scaffold of 50%mass fraction treated with liquid nitrogen , with its strong mechanical intensity and high biological fusibility , can be used as a new carrier of bone tissue engineering scaffolds .

Three cases of Langerhans cell histiocytosis (LCH)with central diabetes insipidus as the first manifestation were reported, with the summary of their clinical manifestations, laboratory examinations, imaging examinations, pathological results, diagnosis process, and treatment response. All three patients presented with central diabetes insipidus in the early stage. The pituitary magnetic resonance imaging (MRI)showed thickened pituitary stalks, and all lost the normal high signal of the posterior pituitary. Two patients showed isolated hypothalamic-pituitary lesions, while one case showed pituitary and thyroid systems involvement. Pathological findings showed typical Langerhans cells, immunohistochemistry showed positive for S-100, CD1a, Langerin. The clinical manifestations of LCH manifested distinct heterogeneity, which is easy to be misdiagnosed and left out. The diagnosis should be confirmed by pathological examination. The biopsy of isolated hypothalamic-pituitary lesions is difficult. It is recommended to actively screen other organs to increase the probability of biopsy. LCH-induced neurohypophysis requires life-long hormone replacement therapy.

OBJECTIVETo explore the effective method of preventing cubitus varus deformity in nonoperative treatment of humeral supracondylar fracture in children.

METHODSFrom May 1992 to December 2013,319 patients with hemeral supracondylar fracture in children were treated with manual reduction and external plaster fixation in extension position. There were 253 males and 66 females, aged from 15 months to 13 years old with an average of 6.7 years. Among the patients with humeral supracondylar fracture, extension type was in 284 cases and inflexion type was in 35 cases; 167 cases on the left and 152 cases on the right. Injury to treatment time was 1 hour to 7 days with a mean of 1.8 days. No included nerve injury and operative case in the patients.

RESULTSAll patients were followed up from 3 months to 14 years with an average of 37.3 months. All fractures obtained bone healing and healed time was 6 to 8 weeks with an average of 6.9 weeks. No complications of serious cubitus varus deformity,vascular nerve injury or volkmann contracture were found. In 183 cases, the carrying angle was consistent with itself contralateral,ranged from 5° to 15°; in 105 cases, the carrying angle of uninjuryed side was decreased. During the reset, the carrying angle of 26 patients with ulnar deviation angle was for -5° to 0°; and 5 patients with radial deviation angle was for 15° to 18°, basically does not affect the appearance. The activities of all elbow joint were normal.

CONCLUSIONExternal plaster fixation in extension position has some value to preventing cubitus varus deformity in nonoperative treatment of humeral supracondylar fracture in children and hope that more scholars to do further study.

Adolescent ; Casts, Surgical ; Child ; Child, Preschool ; Female ; Fracture Fixation ; methods ; Humans ; Humeral Fractures ; surgery ; Infant ; Male