Owing to the specific distribution and pathology of intracranial giant aneurysm, the parent artery must frequently be interdicted. In order to avoid cerebral ischemia, many neurosurgeons create effective techniques of extracranial intracranial artery bypass(EIAB) for the treatment of intracranial giant aneurysm. In this review, the author summarized advances in the application of EIAB for the treatment of intracranial giant aneurysm.

Objective To investigate the salty, efficacy and feasiblify on eholedochotomy with endobiliary drainage and prumary closure of the common bile duct. Methods There were 20 partients without introhepatic or re-tained stones and biliary stricture underwent common bile duet exploration. 20 of them with endobiliary tube drainage and primary CBD closure and the other 20 patients with T tube drainage. Results The average of the time to return routine home was (9. 2 ±1. 3)d, (15. 2 ± 3.6) d(P < 0. 01). The hospital expense of postoperation was (3 252± 312)Yuan,(4 116±388)Yuan(P<0.01). Conclusion Choledochotomy with endobiliary catheter and primary closure of CBD is a safe, effective and feasible procedure for the management of choledochohthiasis.

ObjectiveTo study the diagnosis and trea tm ent of bilateral renal angiomyolipomas.MethodsThe clin ic data of 13 cases of bilateral renal angiomyolipoms were reviewed.There were 2 male and 11 female patients with an average age of 42.Preoperative ultrasonogra phy and CT scanning have been undertaken in all.Renal angiomyolipoma was diagnos ed in 11 and cancer nodules could not be ruled out in the other 2.Unilateral and bilateral renal sparing surgerys were carried out in 5 and 8 cases respectively .ResultsAll cases were examined with rapid frozen sect ion analysis at operations.The renal function of all the patients except 1 was n ormal after operation except 1 with a temporary rise in Scr (350 ?mol/L).The pa tients have been followed up 1 to 4 years after discharging from hospital and th e renal function became normal in all.No recurrence was found.Conc lusionsUltrasonography and CT are important methods to diagnose ang iomyolipoma with specific manifestations.Rapid frozen section analysis at operat ions is helpful to diagnose and to choose the correct surgical technique.Attenti on should be paid to reserve the renal tissues as much as possible and renal fun ction should be protected properly.

Objective To study the impact of temperature, light, nitrogen and phosphorus on growth and microcystin-LR production of Microcystis aeraginosa strain under laboratory conditions. Methods M.aeraginosa strain was cultivated in BG-11 medium. Growth was determined by counting cell, while microcystin-LR was analyzed by high-performance liquid chromatography. Results M.aeraginosa strain had a biggest growth rate at temperature of 25 ℃ and light intensity of 3 000 lx, while microcystin-LR production contents reached maximum at 20 ℃ and 5 000 lx respectively. Under the phosphorus-fixed condition, M. aeraginosa amount and mircrocystin-LR content increased by nitrogen concentration and reached the peak when the nitrogen concentration was 650.0 ?mol/L. But higher concentration of nitrogen could probably restrain the cell growth and toxin production. Under the nitrogen-fixed condition, M. aeraginosa strain grew slowly at phosphorus concentration of 1.43 ?mol/L, but had a higher growth rate when phosphorus concentration was 6.50 ?mol/L. No significant change was found with the increase of phosphorus concentration. And almost similar contents of microcystin-LR produced by M. aeraginosa were observed at different phosphorus concentrations. Positive correlations between total microcystin-LR concentrations and chlorophyll-a contents and M. aeraginosa cell densities were found. Conclusion The optimum conditions for growth and toxin production of M. aeraginosa are not the same. Phosphorus is a probable limitation nutrient factor, and a low concentration will satisfy the growth and toxin production of M. aeraginos. The N∶P atomic ratio at 100∶1 was determined as the optimum for growth and toxin production. The total microcystin-LR concentration can be forecasted by M. aeraginosa cell density or chlorophyll-a content.

Objective To explore the imaging features of pediatric splenic primary solitary tumor. Methods The medical imaging appearances of 6 children with splenic primary solitary tumor conifrmed by surgery and pathology from January 2010 to August 2015 were retrospectively studied. The related literatur were reviewed. Results In 6 children, 2 children of cystic lesions, ultrasound showed anechoic mass, CT scan showed low density mass, without change after contrast, pathologically conifrmed as congenital cyst;2 children’s ultrasound showed solid echo, color Doppler ultrasound explored the blood lfow signals, contrast CT showed the lower strength around the splenic parenchyma, pathologically conifrmed as splenic lymphangioma;one child’s unltrasound showed echo mass with rich signals of blood lfow, MRI scans showed T1WI, T2WI and other signals of lumps, with little homogenity after contrast, pathologically conifrmed as splenic hamartoma;one child’s ultrasound cannot distinguish tumor boundaries, contrast CT scan showed concentric filling reinforcement, pathologically confirmed as hemangioma. Conclusion Splenic primary solitary tumor in children is rare. There are no speciifc clinical characteristics. The image ifndings can deifne the locations and help the differential diagnosis. The ifnal diagnosis depends on pathology.

Objective To evaluate the sonography features of heptaobiliary involvement of pediatric Langerhans′cell histiocytosis ( LCH) . Methods Nine pediatric patients with LCH confirmed by the clinical presentation ,biochemical tests and pathologic results of our hospital were retrospectively analyzed . Results Eight patients were seen in multi‐system LCH ,while one patient only had liver involved . All patients showed varying hepatomegaly with multiple distributed lesions in ultrasound images . According the lesion distribution features ,they could be classified into three types:central type(6/9) ,peripheral type(1/9) and diffuse type(2/9) . In ultrasonography ,they manifested as linear lesions alongside the central portal veins , multi‐nodular and randomly distributed lesions in liver parenchyma ,or both of them . Eight bile‐duct involved patients behaved with unevenly thicked bile‐duct walls ,stenosis or dilated bile‐ducts ,and even sclerosing cholangitis , some of them with cholelithiasis . Conclusions Pediatric LCH patients with heptobiliary involved are seemed mainly in multi‐system LCH ,while it is rare but possible that pathological Langerhans′cell only infringe on liver and bile‐ducts . The ultrasound imaging findings of pediatric LCH liver infiltration are with characteristic and are helpful for the early diagnosis and clinical procedure .

BACKGROUND: Cardiospecific proteins of the troponin-tropomyosin complex in the contractile system of the cardiomyocytes have challenged creatine kinase isoenzyme MB (CK-MB) as the "gold standard" for the early biochemical detection of acute myocardial injury.OBJECTIVE: To investigate cardiac troponin Ⅰ messager RNA (cTnI-mRNA) in peripheral blood and its clinical values in diagnosis of patients with myocardial injury.DESIGN: A basic and observational study for set up a method to analyze cTnI-mRNA.SETTING: Department of Cardiology, Affiliated Hospital, Nantong University.MATERIALS: The project was accomplished from May 2003 to May 2005 in Research Center of Clinical Molecular Biology, and Department of Pathology, Affiliated Hospital, Nantong University. The cTnI-mRNA was detected from blood by a nested PCR assay, and its clinical values as a sensitive myocardial diagnostic marker were confirmed in patients with myocardial injury.METHODS: Pathologic features and microstructure of cardiac myocytes were examined by H&E staining or electron microscopy. The cTnI-mRNA was extracted from blood and synthesized to cDNA through random primers and reverse transcriptase, and amplified by a nested PCR assay, and its clinical values as a myocardial diagnostic marker were investigated in patients with myocardial injury.MAIN OUTCOME MEASURES: Microstructure of cardiomyocytes, sensitivity of analysis method and diagnostic values.RESULTS: Microstructure of cardiomyocytes with mitochondria swell,rupture, vacancy-like denaturation, nucleus abnormality, and chromatin condensed were observed by electron microscopy. The cTnI-mRNA fragments from heart and blood were successfully amplified and the sensitivity was 2 pg/μL. The product sequences from tissues or blood were confirmed by sequencing. The cTnI-mRNA from cardiac myocytes was found that it present in blood plasma and not in circulating nucleus cell. The incidence of blood cTnI-mRNA of chronic cardiomyopathy was significantly higher (P ＜ 0.05) than that of serum enzymatic patterns or cTnI quality,respectively.CONCLUSION: The analysis of blood cTnI-mRNA is a sensitive marker for diagnosis and monitoring of myocardial injury.

BACKGROUND: Neuroprotective role of hypothermia on cerebral ischemic-reperfusional impairment has been long acknowledged. Since general hypothermia is complicated and unfit for observing postoperative consciousness and neurological function, it is of important significance to explore novel methods of focal cerebral hypothermia.OBJECTIVE: To study the neuroprotective effect of lateral ventricle infusion of low-temperature fluid on ischemic neurons of middle cerebral artery (MAC) occlusion models established on New Zealand rabbits.DESIGN: A randomized case-control study based on experimental animal models.SETTING: Neurosurgical department and pathological department of a general military hospital of Chinese PLA.MATERIALS: This study was carried out at Neurosurgical Laboratory of Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA. Altogether 18 healthy New Zealand male rabbits, weighing from 2. 8 to 3.2 kg, were selected 4 - 6 months after birth, and randomly divided into occlusion group, hypothermia group and control group.INTERVENTIONS: Cerebral focal ischemic-reperfusional model was established on the New Zealand rabbits through MCA occlusion for 2 hours followed by reperfusion for 24 hours.MAIN OUTCOME MEASURES: Scores for neurological function, water content in the left and right brain, pathological changes of nerve cells in the left MCA supplying region.pothermia group, significantly higher than that in occlusion group(7.58 ± 0.58 )( P ＜ 0.01 ), but no significant difference could be observed in contrast with brain was(81.64 ± 0.82)% and (79.26 ± 1.30)% in occlusion and hypothermia groups with significant difference between them( P ＜ 0.05), and it was significantly different between the left side [ (81.64 ± 0. 82 )% ] and opyknosis and deep staining could be observed in nerve ganglion cells in occlusion group under optical microscope, but no obvious pathological changes were observed in MCA supplying brain regions in hypothermia group.CONCLUSION: Permanent infusion of low-temperature fluid into the lateral ventricle plays an important neuroprotective role by attenuating cerebral ischemic-reperfusional impairment and improving post-ischemic neurological functions.

Objective To investigate the peripheral blood Th17 and CD4 + CD25 + regulatory T cell levels and their correlations in patients with primary hepatocellular carcinoma (PHC).Methods Peripheral blood samples were collected from 30 PHC patients and 25 healthy controls in the First Affiliated Hospital of Zhejiang University from June 2008 to May 2009.Mononuclear cells were isolated and the Th17 and CD4 + CD25 + regulatory T cells were detected by flow cytometry and compared between patients and controls by t test.Spearman test was performed to analyze the correlation of Th17 with CD4 + CD25 +regulatory T cell concentrations.Results The levels of Th17 and CD4 + CD25 + regulatory T cells in peripheral blood in healthy controls were (2.10 ± 0.87) ％ and (7.10 ± 2.32) ％ ; while those in PHC patients were (3.38±1.68)％ and (11.78±5.62)％ (t=3.640 and 4.162,P＜0.01).The level of Th17 cells was positively associated with that of CD4 + CD25 + regulatory T cells in PHC patients (r =0.821,P ＜0.01).Conclusion The levels of Th17 and CD4 + CD25 + regulatory T cells in peripheral blood are high in PHC patients and positively correlated with each other,which indicates that CD4 + CD25 + regulatory T cells may contribute to the disease progression and pathogenesis of carcinoma through inducing Th17 cells differentiation.

ObjectiveTo evaluate and compare the efficacy and adverse effects of recombinant human tumor necrosis factor receptor Ⅱ : IgG Fc protein for injection (etanercept) and methotrexate ( MTX )regimens for rheumatoid arthritis (RA). MethodsForty-six patients were randomly divided into two groups by stratified sampling method:etanercept group,22 patients were treated with 12.5 mg of etanercept,twice times per week by subcutaneous injection;and MTX group,24 patients were treated with 5-10 mg of MTX,once per week by oral administration. The course of treatment lasted 24 weeks in both groups, so as to observe their ACR20, ACR50, ACR70 and adverse effects of the drugs. ResultsAfter treated for 24 weeks,ACR50,ACR70 respectively achieved 54.5％ (12/22),31.8％ (7/22) in etanercept group,which were significantly higher than those in MTX group[16.7％(4/24),4.2％( 1/24)]. The total efficacy was 86.4％ (19/22) in etanercept group, 20.8％ (5/24) in MTX group, the difference between the two groups was significant (P ＜ 0.05 ). The incidence of adverse effects was not significant between the two groups [22.7％(5/22) vs. 50.0％ (12/24)](P ＞ 0.05). ConclusionEtanercept has a good efficacy and safety for the treatment of active RA.