Objective To investigate the relationship in clinical features of invasive pituitary adenoma patients and their aggressive,matrix metalloproteinase 9 (MMP-9),vascular endothelial growth factor (VEGF) expression and tumor invasiveness of pituitary adenomas.Methods 96 patients with pituitary adenoma were selected,46 cases of invasive pituitary adenomas,50 cases of non-invasive pituitary adenomas,MMP-9,VEGF expression were detected by immunohistochemical assay,their expression levels were analyzed with tumor invasiveness correlation.Results MMP-9,VEGF expression in invasive pituitary adenomas strongly positive rates were 54.35％,52.17％,the total positive rates were 89.13％,95.65％,which were significantly higher than the non-invasive pituitary adenomas MMP-9,VEGF strong positive expression rate of 16.00％,20.00％,the total positive rates were 44.00％,56.00％ (x2 =15.618,9.416,21.631,20.090,all P ＜ 0.05);MMP-9,VEGF for invasive pituitary volume under positive circumstances,the maximum diameter was significantly higher than non-invasive of the group (t =4.32,3.67,2.49,2.54,all P ＜ 0.05),and MMP-9,VEGF were under negative circumstances invasive and non-invasive pituitary adenoma group,the difference was not statistically significant(t =1.56,1.47,0.53,0.21,all P ＞ 0.05);By correlation analysis,invasive pituitary adenoma MMP-9 expression was positively correlated with VEGF levels (r =0.734,P ＜ 0.01).Conclusion Invasive pituitary adenomas of MMP-9 and VEGF expression increased,MMP-9 and VEGF can be used as auxiliary judge biological indicators of invasive pituitary adenomas.

Objective To explore the clinical effect of temperature-controlled radiofrequency ablation of tonsil in the treatment of children obstructive sleep apnea hypopnea syndrome(OSAHS).Methods From January 2003 to January 2006,30 patients,confirmed OSAHS by polysomnography(PSG),aging from 3 to 10 years(mean:5.8 years)were treated by temperature-controlled radiofrequency ablation of tonsil,in which 21 cases with adenoidal hypertrophy were treated with adenoidectomy,and 3 of the 21 cases with secretory otitis media received auripuncture.Results Six months after the operation,the symptom of snoring and mouth breathing in all patients disappeared,tonsillar hypertrophy was kept in Ⅰ or Ⅱ grade,no pharynx stenosis was detected,and hearing was recovered to normal.After 1 year,20 cases were monitored with PSG,of which 10 cases were cured,8 cases showed apparent efficacy and 2 cases showed efficacy.Conclusions The temperature-controlled radiofrequency ablation of tonsil is an effective and safe technique in the treatment of children OSAHS.

OBJECTIVE To explore the effect of matrine induced proliferation, apoptosis and auto-phagy on human medulloblastoma cell line D341 in vitro. METHODS D341 cells in vitro were incubated with matrine 0, 0.5, 1.0, 1.5 and 2.0 g.L-1 for 24, 48 and 72 h, respectively. The proliferation of D341 cells was analyzed using Cell Counting Kit-8 assay. Apoptosis was detected by flow cytometry. The mor-phologic change of cells was observed under a transmission electron microscope. The expression of Bax, Bcl-2, caspase 3, microtubule associated protein 1 light chain 3 (LC3) and beclin1 was detected by Western blotting, and the expression of LC3 and beclin1 was detected by Western blotting with or without the autophagy inhibitor 3-methyladenine(3-MA). 3-MA was added 1 h before matrine and the final concentration of 3-MA was 5 mmol.L-1 . RESULTS Matrine significantly inhibited the proliferation of D341 cells. There was a concentration-effect relationship ( r24 h = 0.994, r48 h = 0.992, r72 h = 0.996, P<0.01). Matrine could induce the cell apoptosis (r24 h = 0.937, r48 h = 0.947, r72 h = 0.987, P<0.01). When the concentration of matrine was 2.0 g.L-1 , the inhibitory effect on D341 cell proliferation (r=0.999, P<0.01) and the induction of cell apoptosis (r=0.990, P<0.01) had a time-dependence. When the concen-tration of matrine was 2.0 g.L-1 , the ultrastructure of the D341 cells had obvious change. Cells with acoustic cavitation bubble structure, chromatin condensation, and marginalization were observed after matrine treatment for 24 h. After 48 h treatment with matrine, nuclear chromatin condensation and more vacuoles in the cytoplasm were observed. After 72 h treatment with matrine, cells exhibited apoptotic characteristics with obvious nuclear chromatin condensation, and nuclear fragmentation, significantly increased the larger cytoplasmic vacuoles. Western blotting analysis showed that matrine could increase the expression of Bax (r24 h =0.981, r48 h =0.967, r72 h =0.998, P<0.01), and decrease the expression of Bcl-2 (r24 h = -0.977, r48 h = -0.989, r72 h = -0.968, P<0.01). Matrine could increase the expression of caspase 3 when the effect time was 48 h (r48 h =0.995, P<0.01). Matrine also increased the expression of beclin1 (r24 h =0.989, r48 h =0.986, r72 h =0.966, P<0.01). The autophagy inhibitor 3-MA could reduce this effect ( P < 0.05). Matrine decreased the expression of LC3-Ⅰ but increased the expression of LC3-Ⅱ and thus the ratio of LC3-Ⅰ/ LC-Ⅱ was decreased (r24 h = -0.795, r48 h = -0.886, r72 h = -0.901, P<0.05). 3-MA could reduce the effects of matrine on LC3-Ⅰ and LC3-Ⅱ expression of D341 cells (P<0.05). CONCLUSION Matrine can inhibit proliferation, induce apoptosis and promote autophagy of D341 cells in vitro.

Tablet 912 - II. active ingredients from Fructus Tribuli, was applied for treating 40 cases of cerebral vascular disorders. After a course of 3 months, it was found that the tablet markedly improved the clincal symptoms, lowered the blood viscosity, regulated platelet functions, ameliorated the microcirculation, increased the cerebral blood flow. When compared with Carlan tablet, the action of improving clinical manifestations was basically the same, while for that of correlated clinical indices, 912-II is better than the latter tablet.

AIM:To investigate matrine-induced apoptosis of human medulloblastoma D 341 cells and the ex-pression of Bax , Bcl-2, serine/threonine kinase Akt and phosphorylated Akt ( p-Akt) in vitro.METHODS: D341 cells were divided into experimental groups ( added with matrine at different concentrations ) and control group ( under the same conditions without matrine).The proliferation of D341 cells was analyzed by CCK-8 assay.Apoptosis was detected by An-nexin V-FITC/PI double staining and the expression of Bax , Bcl-2, Akt and p-Akt was detected by Western blotting .RE-SULTS:Matrine significantly inhibited the proliferation of D 341 cells and increased the apoptosis in a dose-and time-de-pendent manner .The cell apoptosis was characterized by chromatin condensation with margination of chromatin to the nu -clear membrane , increased when and larger cytoplasmic vacuoles , and formation of apoptotic body after treatment with ma-trine.The expression of Bax increased , while the expression of Bcl-2 and p-Akt decreased when the drug concentration gradually increased .CONCLUSION:Matrine induces the apoptosis of human medulloblastoma D 341 cells in vitro by acti-vation of Bax, down-regulation of Bcl-2 and reduction of p-Akt expression level in the PI3K/Akt signaling pathway.

Objective: To investigate the changes of gallbadder motive function in diabetics. Method: The size of gnllbadder,recovering rate,echo and half-empty time after fat food were compared and statistically analyzed between 22 healthy individuals and 20 diabetics with ultrssonograph. Results:The gallbadder recovering rate was similar between the healthy individuals and diabetics (P>0.05), but the rate of cholecystitis (30%) and choletethiasis (35%) of diabetics were higher than those in healthy individuals, the gallbadder half-empty time after fat food was obviously slower in diabetics (46.1+12.9 min)than those healthy individuals (27+4.4 mmin). Conclusions: The diabetics had obvious gallbadder motive funciion obstruction and higher rates of chronic cholecystitis and choletethiasis with ultrasonograph observations.

Objective To discuss the clinical outcomes of C1-C2 pedicle screw fixation in treatment of Jefferson fracture combined with aflantoaxial instability.Methods Eleven adult patients with Jefferson fracture combined with atlantoaxial instability were treated with C1-C2 pedicle screw fixation in our department from January 2006 to December 2009.There were eight males and three females at age range of 20-52 years(mean 36 years).There were eight patients with fresh fractures,three with old fracture and three complicated with odontoid process fracture.The main preoperative clinical symptoms were the limitation of head torsion and pain in the occiput and neck,with no spinal dysfunction in all patients.X-ray,CT scan,three-dimensional reconstruction,MRI scan and skull traction were performed in all patients before operation.Then,the patients were treated with C1-C2 pedicle screw fixation without fusion between C1-C2 under general anesthesia.Results The atlantoaxial dislocation was reduced completely and the patients could move from bed,wearing the neck collar.There was no injury of vertebral artery,spinal cord or nerve roots during operation,but one patient suffered the venous plexus bleeding which was packed with the hemostatic gauze.Eleven patients were followed up for 6-24 months(average 15 months),which showed bone union,with no internal fixation breakage,loosening or dislocation.The internal fixation was removed from seven patients 15 months after operation,with mild limitation of the cervical vertebra torsion(90°-135°,average 115°)but with no limitation of obvious extension-flexion motion.Conclusion C1-C2 pedicle screw fixation has features of simple operation,short segment fixation,solid fixation and high rate of bone healing for treatment of Jefferson fracture combined with atlantoaxial instability.

Objective To analyze the clinical characteristics and prognosis of disseminated cryptococcosis in children.Methods The data of disseminated cryptococcosis inpatients were reviewed retrospectively at Beijing Children's Hospital,Capital Medical University,from January 2002 to September 2014.The demographic data,clinical manifestations,laboratory findings,imaging,antifungal treatments and outcomes of all the patients were analyzed.Results Overall 25 children with disseminated cryptococcosis were enrolled including 17 boys(68.0％).The average age was 7 years old.Four cases (16.0％) had underlying conditions,among them 1 case had human immunodeficiency virus(HIV)-positive.The median time to diagnosis was 32 (23-47) days,44.0％ of the patients (11 cases) were misdiagnosed,and 8 cases misdiagnosed as tuberculosis.All patients had fever.Other common clinical manifestations included cough (16 cases),headache (10 cases),vomiting (10 cases),altered mental status (6 cases) and stomachache (6 cases).Respiratory system involvement was seen in all cases,central nervous system was involved in 18 cases,other organ involvement included lymph nodes,spleen,liver,kidney,skin,skeleton and costicartilage.Amphotericin B (AmB) + Fluconazole (Flu) ± 5-flucytosine (5-FC) was the most common therapy (15 cases),Flu ± 5-FC for 6 cases,AmB ± 5-FC for 2 cases,Voricanazole (VOR) for 1 case.Sixteen cases (66.7％) got recovery/improved on discharge,8 cases (33.3％) rejected to the advise and discharged with treatment failure,and the HIV-infected patient transferred to a special hospital.Fifteen patients (60.0％) were followed up,and 13 cases (87.0％) showed recovery,but 2 died in the long-term prognosis.Conclusions Disseminated cryptococcosis in children is more common in school-age boys.Most patients are without underlying conditions.Disseminated cryptococcosis can cause multiple organ damage.Patients with prolonged fever,cough,headache,with or without underlying diseases,can be suspected as disseminated cryptococcosis.Blood and cerebrospinal fluid culture for fungus,cryptococcal antigen should be performed for early diagnosis and treatment.

The teaching for medical advanced students is a routine and important task in teaching hospital.To increase the teaching quality,we should emphasize professional theory learning,increase clinical skill training,strengthen medical records writing training and enhance emotional exchange.

Objective:To explore the feasibilitv of stereotactic minimally invasive aspiration of small thalamic bemorrhage.Methods:Twenty-two patients with small thalamic hemowhage(5 to 10 mL)were divided into two groups:a stereotactic group(n=10)and a control group(n= 12).The patients in the stereotactic group received stereomctic minimally invasive puncture and drainage of hematomas.According to the condition,repeated infusion of urokinase(10-20 kU) into the hematoma cavities were administered 12 hours after the procedure,and the hematomas were irrigated and drained so as to removal of them completely after retaining for 2-4 hours, The appropriate symptomatic treatment was administered in the patients in both groups.National Institutes of Health Stroke Scale(NIHSS)scores were determined 14 and 30 days before and after the treatment in all the patients.The reductiom of the NIJSS scores (as compared with those before treatment)were calculated at day 14 and 30 respectively after the treatment. Results:The reductiom of the NIHSS scores in the stereotactic group at day 14 and 30 were significantly higher than those in the control group.It was suggested that the neurological functional recovery of the patients was faster after stereotmtic minimally invasive puncture and drainage of intracranial hematorna in the stereotactic group.Concision:The stereotactic minimally invasive puncture and drainage of intracranial hematoma may significantly improve the outcome in patients with small thalamic hemorrhage.