Takayasu arteritis (TA) is a devastating vasculitis of the aorta and its major branches,coronary and pulmonary arteries.The clinical manifestations in children are less specific than in adnlts:the disease in children presents with fever,arthralgias,vomiting,weight loss and hypertension.Conventional angiography,which is recognized as the golden standard in evaluating vascular lesions in TA,combined with computer tomography angiography (CTA),magnetic resonance angiography (MRA),ultrasonography,could not only provide important information for early diagnosis,but also detect disease activity.New immunosuppressive agents and biological therapies,such as TNF-a blocking agents,have been verified to be effective although corticosteroids and conventional immunosuppressive agents are still basic treatment.

Objective To study the expression and its significance of bcl-2 associated death (bad) gene in human optic nerves from traumatic atrophic eyeballs. Methods The optic nerves from 8 normal human donor eyes and 31 traumatic atrophic eyes were studied by immunohistochemistry technique. Results Bad protein was positively expressed in the normal optic nerve myelin sheath and residual myelin portions of optic nerve tissues from traumatic atrophic eyes. The expression of bad protein in the residual portions of myelin sheath was stained significantly stronger than that in normal optic nerves (P0 05). Conclusion Bad might possess the function of promoting the optic nerve atrophy processes in traumatic atrophic eyes.

Objective:We probe more direct operation pathways in sphenoidal sinus and saddle area, and take proper measures for correlated diseases which surpass scope of sphenoidal sinus by combining image data, which could prevent serious complication.Method:Under nasal endoscope, the operation approaches we adopted included trans-anterior ethmoid sinus-posterior ethmoid sinus-sphenoidal sinus pathway, trans-meatus nasi superior-posterior ethmoid sinus-sphenoidal sinus pathway, trans nasal septum-sphenoidal sinus pathway and trans-natural opening of sphenoid sinus anterior into sphenoid sinus pathway by taking upper edge of posterior naris as a consistent surgical landmark. Forty-six cases who had sphenoidal sinus mass with bone erosion recieved surgical treatment.Result:Twenty-one cases with cyst and pus cyst of sphenoidal sinus had been healed by trans-meatus nasi superior pathway;1 case with hematoma and organization in sphenoidal sinus had been cleared by trans-meatus nasi superior pathway;3 cases had hematoma and organization in sphenoidal sinus and pseudoaneurysm in internal carotid artery,one of them suffered fatal hemorrhage in surgical exploration, and cured by endovascular embolization, the other two only underwent nasal endoscopic examination,the diagnosis was established by DSA and they received interventional therapy;4 cases with papilloma in sphenoidal sinus had been treated by trans-natural opening of sphenoid sinus approach,and 3 cases were cured,1 case had only partial mass resection as the papilloma offended the outer wall of sphenoidal sinus diffusely;2 cases with cholesteatoma of sphenoid sinus have been removed completely by trans-meatus nasi superior approach;1 case with encephalomeningocele of sphenoidal sinus underwent sphenoidotomy by trans-natural opening of anterior of sphenoidal sinus, and intraoperative puncture showed characteristic cerebrospinal fluid,the exposed meninges were then repaird surgically;1 case with mycosis of sphenoidal sinus had been cured by thorough clearing of the leision in sphenoidal sinus combined with antifungal therapy;3 cases with malignancy of sphenoidal sinus had received major mass resection of sphenoidal sinus by trans-anterior ethmoid sinus-posterior ethmoid sinus approach, and followed with radio therapy and chemotheraphy;5 cases with NPC in-volving sphenoidal sinus had been treated by radio therapy and chemotherapy after pathological examinacation;5 cases with post-operative cerebrospinal rhinorrhea and granulation hyperplasia of sphenoidal sinus had been repaired successfully by trans-meatus nasi superior approach or tans-nasal septum approach.Conclusion:There are various surgical pathways to deal with sphenoidal sinus and correlated diseases under nasal endoscope.The operation will be direct, safe and minimal invasive if we choose the pathway properly. Thin slice CT scan and 3D reconstruction of sella, and DSA or angiography of brain before operation is one of effective means to prevent surgical complications for leisions beyond scope of sphenoidal sinus.

BACKGROUND: Typically antiepileptic drugs, such as phenobarbital, fenitoina sodica and diazepam, can inhibit amygdala kindling effect in rats. However, whether midazolam has the same effect is still unclear.OBJECTIVE: To investigate the inhibitory effect of midazolam on amygdala kindling onset in rats and maximal electroshock seizure (MES) in mice and effeots of antiepileptic drugs.DESIGN: This study was divided into three subexperiments, including the effects of midazolam on amygdala kindling onset, independent activities and incidence convulsion. All the three subexperiments were completely randomized,infra-group control or self-control studies.SETTING: Medical College of Qingdao University.MATERIALS: The experiment was carried out in the Comprehensive Experimental Room, Affiliated Hospital of Medical College of Qingdao University from August 2004 to March 2005. Nine Wistar rats weighing (250±10) g and 120 Kunming mice weighing (20±5) g and either gender were provided by Animal Center of Qingdao Institute of Drug Control.Midazolam (5 g/L) was provided by Xuzhou Enhua Drugs Co., Ltd. (batch number: 20030706).METHODS: ① Establishment of amygdala kindling models: Nine kindled rats were randomly selected and intraperitoneally injected with 0.25, 0.5 and 1 mg/kg midazolam, respectively. Quadri-pathway biological signal processing system (SMUP-PC) was used to measure discharge duration (ADD) and Racine's stage. ② Sixty mice were randomly divided into 5 groups, including saline group, 40 mg/kg phenobarbital group, 0.5, 1.0 and 1.5 mg/kg midazolam groups with 12 mice in each group. And then, numbers of activities in a unit time (times per 5 minutes) were determined by XZC-4A mini-animals independent activity instrument. ③ MES models were established to calculate incidence of convulsion.MATN OUTCOME MEASURES: Effects of midazolam on ADD, Racine's stage, numbers of independent activities and incidence of convulsion.RESULTS: All the 9 rats and the 120 mice were involved in the final analysis. ① Effect of midazolam on amygdala kindling onset: After intraperitoneal injection of 0.5 and 1.0 mg/kg midazolam, ADD and Racine's stage were obviously lower than those before administration (P ＜ 0.05-0.01). After intraperitoneal injection of 0.25 mg/kg midazolam, ADD was obviously lower than that before administration (P ＜ 0.05), but there was no significant difference in Racine's stage. ②Effect of midazolam on independent activities of mice: Numbers of independent activities were lower in the phenobarbital group and 0.5, 1.0 and 1.5 mg/kg midazolam groups than those in the saline group (P ＜ 0.01), while numbers of independent activities were higher in 0.5 mg/kg midazolam group than those in the phenobarbital group (P ＜ 0.05). ③Effect of midazolam on maximal electroshock seizure: Incidence of convulsion was lower in the phenobarbital group and 0.5, 1.0 and 1.5 mg/kg midazolam groups than that in the saline group (P ＜ 0.05-0.01), while Incidence of convulsion was higher in 0.5 mg/kg midazolam group than that in the phenobarbital group (P＜ 0.05).CONCLUSION: Midazolam can significantly inhibit amygdala kindling onset, reduce numbers of independent activities,and antagonist MES in mice.

BACKGROUND: There exists insufficient study with specific applicability regarding vascular distribution characteristics of sural nerve nutrient vessels of the distally based flap.OBJECTIVE: To investigate the distribution of sural nerve nutrient vessels of the distally based flap and provide an anatomical evidence for the design of operation on repair of foot injury.DESIGN: A single sample study.SETTING: Research Center of Clinical Anatomy, Fuzhou General Military Hospital of Nanjing Military Area Command of Chinese PLA, and Department of Orthopaedics, the 97 Hospital of Chinese PLA.PARTICIPANTS: Thirty-two samples of lower extremities whose blood vessels were perfused with red emulsion were provided by Research Center of Clinical Anatomy, Fuzhou General Military Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: The origin of the blood vessels of distally based flap and deep communicating branches of the lesser saphenous vein in the samples were dissected and observed.MAIN OUTCOME MEASURES: ①The nutrient vessels of sural nerve of distally basde flap.②The nutrient vessels of lesser saphenous vein of distally based flap.③The superficial and deep communicating branches of lesser saphenous vein of distally based flap.RESULTS: There were 2 to 5 nutrient vessels in the distally based flap:one originating from the perforating branch of the lateral calcaneal artery was (0. 6 ± 0.2) mm in diameter and one from the terminal perforating branch of the peroneal artery was(0.8±0. 2) mm in diameter and they were (1.0 ± 1.3) and(2. 8 ± 1.0) cm, respectively, away from the lateral malleolus. The incidence of intermuscular septum perforating branches (0 to 3) was 96. 7%, 66.7% and 20. 0%, respectively, and their diameter was (0.9 ±0. 3), (1.0 ±0. 2) and (0. 8 ±0. 4) mm and their distance to lateral malleolus was(5.3 ±2. 1), (6. 8 ±2.8) and (7.0 ±4.0) cm, respectively. There were 2 types of nutrient vessels of the lesser saphenous vein of distally based flap, the nutrient vessels of nerve-vein and the ones of vein-nerve. The superficial and deep communicating branches of the lesser saphenous vein were(1.7 ±0. 5) mm in diameter and(3.4 ±0. 9) cm away from the lateral malleolus. They ended at the peroneal veins.CONCLUSION: The perforating branches of heel lateral artery, the terminal perforating branches and intermuscular septum perforating branches of the peroneal artery have sub-branches to deep fascia, skin, nerves and parenteral nutrient vessels. These sub-branches communicate and form vascular chain of lesser saphenous vein to sural nerve and vascular network of superficial and deep fascia. The superficial and deep communicating branches end at the peroneal veins.

BACKGROUND:In recent years, endoplasmic reticulum stress-caused apoptosis plays a crucial role in ischemia impairment and has become the hotspot of studies addressing myocardial ischemia/reperfusion (I/R) injury. The lower limb ischemic preconditioning (LIP) has the obvious protective effect on the immature myocardium, but until now, no study reports whether LIP effects on endoplasmic reticulum stress apoptosis in immature myocardial cells. OBJECTIVE:To investigate the effect of LIP on endoplasmic reticulum stress and apoptosis.
METHODS:Langendorff-perfused isolated rabbit hearts were used in this study. Twenty-four immature rabbits were randomized into three groups. Control group:Isolated rabbit heart was only perfused with Krebs-Henseleit for 180 minutes. I/R group:Isolated rabbit heart was perfused 20 minutes, and then ischemia for 60 minutes fol owed by reperfusion 100 minutes. LIP group:Limbs were repeatedly obstructed 5 minutes and relaxed 5 minutes for three times, to establish Langendorff models, and then repeated the method of ischemia/reperfusion in I/R group. The myocardial apoptosis was assayed with TUNEL method. The expression of glucose-regulated protein 78, Bcl-2, Bax and Fas was detected with western blot analysis.
RESULTS AND CONCLUSION:Compared with I/R group, apoptosis rate was significantly lower, the expression of Bcl-2 was significantly higher, and the expression of glucose-regulated protein 78, Bax and Fas was significantly lower in LIP group. This study demonstrated that LIP regulates myocardial cellapoptosis through reducing the expression of endopasmic reticulum stress GRP78, Bax and Fas and increasing the expression of Bcl-2.

Objective To investigate the effect of electro-acupunctare at zusanli on acute lung injury in a rat model of sepsis after scald.Methods Fifty SPF male Sprague-Dawley rats,weighing 200-250 g,aged 2-3 months,were randomly divided into 5 groups (n =10 each) using a random number table:control group (group C),sepsis after scald group (group SS),electro-acupuncture at zusanli group (group E),electric stimulation of non-acupoint group (group NE) and electro-acupuncture at zusanli + α-bungarotoxin (α-BGT,a selective α7 nicotinic acetylcholine receptor antagonist) group (group α-BGT).The rats were subjected to a third degree scald covering 20％ total body surface (TBS) and muramyl dipeptide (MDP) 5 mg/kg was injected into the femoral vein immediately after scald to induce sepsis.Electro-stimulation (3 V,2 ms,3 Hz) of bilateral zusanli was performed for 12 min starting from the time point immediately after MDP injection and every 8 h for 2 consecutive days in group E.In group NE,electro-stimulation was performed at the points 5 mm lateral to the bilateral acupoints of Zusanli and the method was similar to those previously described in group E.In group α-BGT,α-BGT 1.0 μg/kg (in 1 ml of normal saline) was injected into the femoral vein before electro-stimulation of zusanli.At 48 h after treatment,arterial blood samples were obtained for determination of serum tumor necrosis factor-alpha (TNF-α) and high mobility group box-1 (HMGB1) protein levels (by ELISA) and lung specimens were removed for microscopic examination and for determination of the expression of Nod like receptor 2 (NLR2) mRNA (by RT-PCR) and receptor interacting protein 2 (RIP2) in the lung tissues (by Western blot).Results Compared with group C,the expression of NLR2 mRNA and RIP2 was significantly up-regulated,and the serum TNF-α and HMGB1 levels were increased in SS,NE and α-BGT groups (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group E (P ＞ 0.05).Compared with group SS,the expression of NLR2 mRNA and RIP2 was down-regulated,and the serum TNF-α and HMGB1 levels were decreased in group E (P ＜ 0.05),and no significant change was found in the parameters mentioned above in NE and α-BGT groups (P ＞ 0.05).Compared with group E,the expression of NLR2 mRNA and RIP2 was significantly up-regulated,and the serum TNF-α and HMGB1 levels were increased in NE and α-BGT groups (P ＜ 0.05).The pathological changes of lung tissues were significantly reduced in group E as compared with group SS.Conclusion Electro-acupunctare at Zusanli can reduce acute lung injury in a rat model of sepsis after scald and inhibition of NLR2/RIP2 signaling pathway and activation of cholinergic anti-inflammatory pathway in lung tissues may be involved in the mechanism.

To study the correlation between traditional Chinese medicine (TCM) syndrome type and the ultrasound imaging changes in patients with limb lymphedema, and to provide evidence for TCM syndrome differentiation.

Objective To analyze the CT signs and the clinical relevant factors of degenerative osteoarthritis of athnto-odontoid joint.Methods The CT signs and the clinical information of 214 patients received CT scans of skull from June 2011 to April 2012 were analyzed retrospectively.Results One hundred and twenty patients were diagnosed with degenerative osteoarthritis of atlanto-odontoid joint,while 67 of them having subaxial degenerative osteoarthritis at the same time.Forty-three patients had a history of chronic cervical and occipital pain.95.83％ (115/120) patients showed osteophytes in CT scans,while 44.17％ (53/1 20) showed calcification around dens and 24.17％ (29/120) showed joint space obliteration.The incidence rate increased with age.Seventy-seven patients [64.17％(77/120)] appeared cervical and occipital pain.Conclusions Degenerative osteoarthritis of atlanto-odontoid joint shows hyperostosis,osteophytes at the edge of joint,joint space obliteration and calcification around dens in the CT scans.The incidence rate is increased with age and correlated with cervical and occipital pain.

Objective To establish the pharmacodynamic model of sevoflurane with bispectral index (BIS) as the effective index in pediatric patients.Methods Thirteen ASA physical status Ⅰ or Ⅱ pediatric patients,aged 4-9 yr,weighing 12-39 kg,undergoing non-cardiac surgery,were selected in the study.The pediatric patients sequentially inhaled 1％,5 ％ and 1％ sevoflurane via a face mask and each concentration was inhaled for 15 min.BIS value,HR,BP and SpO2 were automatically recorded every 10 s.Based on nonlinear mixed effect modeling,the population pharmacodynamic model of sevoflurane was established using NONMEM software.The effect of age on the pharmacodynamic parameters was evaluated using a stepwise forward addition then backward elimination modeling approach.The standard for model improvement was defined as a decrease in the value of the objective function by more than 3.84.Results Twelve pediatric patients,aged 4.0-8.5 yr,weighing 12.8-38.0 kg,with body height of 92-135 cm,were enrolled in this study and the data which were enrolled comprised 2964 effective concentration-time-BIS points.The model was not improved significantly with any covariates (age,body height,and body weight) introduced (P ＞ 0.05).The estimated parameters of the final pharmacodynamic model of sevoflurane were as follows:ke0 =O.516/min ; EC50 (BIS50) =2.11％ ; γ =2.46 ; E0 =74.6 ; EMAx =11.2.Conclusion The pharmacodynamic model of sevoflurane is successfully established with BIS as the effective index in pediatric patients,and the analysis for each parameter of the model indicates that the sensitivity to sevoflurane is lower,but the blood-brain equilibration time of the drug is shorter and the onset and recovery are faster in children than in adults.