Objective To report secondary paroxysmal sympathetic hyperactivity in a patient with tuberculous meningitis and to review the diagnostic criteria, clinical features, possible pathogenesis and management of this condition. Methods The clinical data of a case with paroxysmal sympathetic hyperactivity secondary to tuberculous meningitis was retrospectively analyzed and related literature was reviewed. Results A 1-year-old boy was admitted to our institute with a history of lethargy and vomiting for 3 days. Neurological examination revealed abnormalities. A lumbar puncture revealed the evidence of meningitis. PPD test, T-SPOT.TB and radiological examination revealed tuberculous meningitis. Later, when stayed in the intensive care unit, he developed paroxysmal hypertension, sinus tachycardia, tachypnea, dystonia, and high fever. These episodes improved after administration of propranolol, benzodiazepines and artane. Conclusions Paroxysmal sympathetic hyperactivity is a rare manifestation of tuberculous meningitis, early recognition is very important for avoid misdiagnosis and overtreatment.

Objective: To analyze the effect of cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF) combining left bundle branch block (LBBB) conformed to new diagnostic standard. Methods: A total of 19 CHF patients who received CRT in our hospital from 2005-06 to 2013-05 were studied. The patients were divided into 2 groups: True LBBB group,n=13 patients conformed to new diagnostic standard and False LBBB group, n=6 patients conformed to traditional diagnostic standard. Pre- and Post-operative LVEF, LVEDD, QRS duration (QRSd) and IVMD were compared in all patients; post-operative LVEF, LVEDD, QRSd, IVMD and Tmsv16-SD, Tmsv16-Dif were compared between 2 groups. Results: The post-operative LVEF, LVEDD, QRSd and IVMD were improved than pre-operative condition in both groups. Compared with False LBBB group, the improvements were more obvious in True LBBB group as LVEDD by mm (5.95±0.72 vs 7.13±0.78), IVMD by ms (22.45±8.00 vs 27.63±13.09), and QRSd by ms (140.38±5.80 vs 153.68±14.38), all P<0.01. The post-operative LVEF and Tmsv16-SD, Tmsv16-Dif were similar between 2 groups. Conclusion: CHF patients combining either true or false LBBB could be beneift from CRT, while the patients with true LBBB may receive better clinical outcomes from CRT.

Objective To construct the recombinant X-linked inhibitor of apoptosis protein(XIAP) gene 3′untranslational region (3′UTR)-luciferase reporter vector ,and analyze the microRNA(miRNA) which possibly regulate the expression of XIAP gene . Methods Polymerase chain reaction (PCR) was employed to amplify X IA P-3′UTR sequences from human cDNA ,in which luciferase reporter vector pGL3-Ctrl was inserted ,and the recombinant vector pGL3-Ctrl/XIAP was gained .Target Scan 6 .2 soft-ware was adopted to predict the miRNA which possibly combined with the X IA P-3′UTR .pGL3-Ctrl/XIAP recombinant plasmids and the miRNA were co-transfected into A549 cells ,and the X IA P-3′UTR-luciferase activity was measured .Results Confirmed by digestion and DNA sequencing ,the X IA P-3′UTR-luciferase reporter recombinant was successfully constructed .Prediction of miRNA target sites indicated that X IA P gene may be the target of miR-200b ,miR-200c and miR-429 .Compared with miRNA mim-ic ctrl group ,miR-200b ,miR-200c and miR-429 significantly reduced the luciferase activity of pGL 3-Ctrl/XIAP with statistically significant difference(P<0 .05) .Conclusion X IA P-3′UTR-luciferase reporter vector is successfully constructed .miR-200b ,miR-200c and miR-429 can obviously decrease the luciferase activity .

Objective To investigate the significance of an accessory hepatic vein (AHV) in the interventional treatment of Budd-Chiari syndrome (BCS).Methods From Mar.2011 to Jun.2013,35 patients with BCS who also had an AHV were included into this study.The patients were divided into two groups according to whether the AHV was obstructive:21 patients had obstruction to the inferior vena cava (IVC) and to the 3 hepatic veins (HV),but the AHV was open; 14 patients had obstruction to the AHV and the 3 HVs.In 13 of these patients the IVC was open,but 1 patient had obstruction to the IVC.During treatment,the patients in the AHV open group underwent balloon dilation or stent insertion of IVC ; patients in the AHV obstruction group underwent balloon dilation or stent insertion of AHV.The patient with obstruction to the IVC underwent balloon dilation of IVC first.Results All patients were successfully treated without any procedure-related complications.In the AHV open group,the average pressure of the AHV decreased from (28.81 ± 6.23) cmH2 O (1 cmH2O =0.098 kPa) before treatment to (18.62 ± 5.06) cmH2O after treatment (P ＜ 0.01) ; the average serum TBIL decreased from (23.24 ± 6.41) μmol/L before treatment to (19.52 ± 4.31) μmol/L after treatment (P ＜ 0.01) ; the average serum albumin changed from (33.76 ± 3.74) g/L before treatment to (34.05 ± 3.62) g/L after treatment (P =0.485).In the AHV obstruction group,the average pressure of the AHV decreased from (36.29 ± 11.65) cmH2O before treatment to (22.07 ± 7.67) cmH2O after treatment (P ＜ 0.01) ; the average serum TBIL decreased from (31.24 ± 9.54) μmol/L before treatment to (20.93 ±7.26) μmol/L after treatment (P ＜0.01) ; the average serum albumin changed from (32.14 ± 4.55) g/L before treatment to (32.11 ± 4.47) g/L after treatment (P =0.861).During follow-up,no patients experienced recurrence of symptoms in the AHV open group; one patient experienced recurrence of symptoms 5 months after treatment in the AHV obstruction group.This patient received a second balloon dilation of the AHV.Conclusions For patients with BCS with IVC and the 3 HVs obstruction,if the AHV was open,we could only treat the IVC.For patients with BCS with AHV and the 3 HVs obstruction,AHV dilation followed by recanalization of AHV was also effective.

Subtilis bacillus spores for novel vaccine delivery has attracted significant interest of more and more researchers by their unique biological characteristics. In this review,the structure and immunogenicity of spores were briefly discussed, then special emphasis placed on the use of recombinant spores as vaccine delivery vehicles,some ideas for further studies on surface display of recombinant vaccines on Subtilis bacillus spores were also proposed

AIM:Investigating the expression of HIF-1α,apoptosis of retinal cells and the role of HIF-1α in apoptosis in rats' retinal ischemia-reperfusion injury.METHODS:The rat model of experimental retinal ischemia-reperfusion injury was established by increasing the intraocular pressure to 110mmHg(1kPa=7.5mmHg)in rat eyes.At different time points of post ischemia,the expression of HIF-1α of the retina was detected by immunohistochemicalstaining,and apoptosis of the retinal cell was detected by terminal deoxynudeotidyl transferase medialed deoxyuridine triphosphatebiotin nick end labeling(TUNEL).RESULTS:HIF-1α appeared in the cells of retinal ganglion layer and inner nuclear layer at 2 hours after ischemia.The expression reached to a peak,12 hours after retinal ischemia-reperfusion,then the expression was dedined.The apoptotiC Cells were mainly in inner nuclear layer and could be detected at the 12th, 24th and 48th hour after ischemia,the peak value was the group of 24th hour.CONCLUSION:Expression of HIF-1α in the rats' retina is greatly enhanced after ischemia-reperfusion,which may be involved in the retinal injury:the injury of retinal neurons Occurs partly in the form of apoptosis.The expression of HIF-1α may play an important role in cell apoptosis.

Background Neurofibromatosis type 1 (NF1) is the most common genetic syndrome predisposing patients to various tumors due to dysregulation of the Ras signaling pathway.Recent research has shown NF1 patients also suffer a spectrum of bone pathologies.The pathogenesis of NF1 bone diseases is largely unknown.There is no current treatment.By Nf1 heterozygote (Nf1+/-) mice and Nf1 conditional knockout mice,we and other groups demonstrated abnormal osteoblast and osteoclast function due to dysregulation of Ras signaling.However,the specific downstream effector pathways linked to NF1 abnormal osteoblastogenesis and osteoclastogenesis have not been defined.In this study,we investigated the Ras downstream effector related with NF1 bone disease.Methods We used Nf1+/+ and Nf1+/-mice as normal and NF1 models.Bone stromal cells extracted from Nf1+/+ and Nf1+/-mice were induced osteoclasts.The osteoclast cell was stained by tartrate resistant acid phosphatase staining.The osteoclast cell number was counted and the surface area of osteoclast cells was calculated under the microscope.The mRNA of mammalian target of rapamycin (mTOR) was determined by quantitative reverse-transcription-polymerase chain reaction.The presence of ribosomal protein S6 kinase was determined by Western blotting.Results Compared with Nf1+/+ mice,Nf1+/-mice had about 20％ more of osteoclast cells.These osteoclast cells werelarger in size with more nuclei.Hyperactive mTOR was detected in Nf1+/-osteoclast cells.Inhibition of mTOR signalingby rapamycin in Nf1+/-osteoclasts abrogated abnormalities in cellular size and number.Conclusion mTOR pathway inhibition may represent a viable therapy for NF1 bone diseases.

Objective To evaluate the safety and efficacy of interventional treatment of occlusion of the entire inferior vena cava (IVC).Methods The clinical data of 6 patients with entire IVC occlusion were analyzed retrospectively.All patients were diagnosed by color Doppler ultrasound and DSA.Venography was performed under local anesthesia via internal jugular vein and femoral vein approach.The occlusion of IVC and hepatic vein were treated with balloon dilatation and/or stent placement.Follow-up examination with color Doppler ultrasound was taken 1,3,6,12 months after treatment and annually thereafter to assess the patency of IVC and hepatic vein.The pressure gradient of hepatic vein-right atrium and IVC-right atrium before and after interventional treatment were compared with paired t test.Results In 5 cases,both IVC and 1 hepatic vein were recanalized successfully.In 1 case,recanalization of IVC failed,but the right hepatic vein was recanalized successfully.The mean pressure gradient of hepatic vein-right atrium decreased from (23.2 ± 2.0) cmH2O (1 cmH2O =0.098 kPa) before treatment to (8.7 ± 3.2) cmH2O after treatment in 6 cases (t =21.6,P ＜ 0.05).The mean pressure gradient of IVC-right atrium decreased from (26.6 ± 2.7) cmH2O before treatment to (9.4 ± 1.1) cmH2O after treatment (t =16.1,P ＜ 0.05).Abdominal pains occurred in 3 patients after stent implantation which disappeared in 24 hours.No other complications such as bleeding and death occurred.During a mean follow-up of(42 ± 27)months (16 to 90 months),hepatic vein patency was maintained in 6 cases and IVC patency was maintained in 5 cases.Conclusion Interventional treatment of occlusion of the entire IVC is a safe and effective method.

Objective To investigate the value of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction.Methods A retrospective study was conducted on 25 patients with Budd-Chiari syndrome (BCS) with hepatic vein obstruction treated from May 2011 to August 2014.The technique of guide-wire loop was used in these patients.The pressure of the hepatic vein was measured before and after treatment.The difference in the pressure was analyzed by the t test.Results All the patients were treated successfully using guide-wire loop angioplasty.No complications of bleeding,pericardial tamponade and liver capsule hemorrhage were observed.After treatment,the pressure of the hepatic vein reduced from (48.3± 8.0) cmH2O to (20.9 ± 3.8) cmH2O (t =26.82,P ＜ 0.05);The symptoms and physical signs of the patients were relieved or disappeared.BCS-related symptoms reappeared on follow-up in 4 patients,2 were treated by balloon dilation successfully.1 patient was treated with transjugular intrahepatic portosystemic shunt (TIPS) because of decompensated liver cirrhosis.1 patient with ankylosing spondylitis had treatment failure and the symptoms relapsed for the third time.Conclusion The technique of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction is safe and effective,and it can improve the overall success rate of treatment.

Objective To explore the therapeutic efficacy of endovascular embolization for the treatment of tiny intracranial aneurysms (≤3.0 mm) and to discuss its technical skill. Methods During the period from Dec. 2010 to July 2013, a total of 12 patients with tiny intracranial aneurysms (≤3.0 mm) were admitted to authors’ hospital to receive endovascular embolization therapy. Of the 12 patients, narrow-necked aneurysm (neck-to-body ratio ≤0.5) was seen in 7 and embolization with coils only was carried out, while wide-necked aneurysm (neck-to-body ratio > 0.5) was seen in 5 and stent-assisted coils embolization was adopted. Based on Raymond grading standard, the immediate therapeutic results were evaluated, and the procedure-related complications were recorded. Thirty days after the treatment , GOS grade was used to assess the results. Follow-up evaluation with angiography or through call was conducted. Results Successful embolization of the aneurysm was obtained in all the 12 aneurysms , with a success rate of 100%. Angiography performed immediately after the treatment showed that complete embolization was achieved in 8 aneurysms (66.7%) and residual aneurysm cavity was seen in 4 aneurysms (33.3%). GOS grading indicated that 12 cases belonged to grade V. The 12 patients were followed up for 1 - 12 months through telephone , and no re-bleeding occurred. Conclusion For the treatment of tiny intracranial aneurysms (≤ 3.0 mm), endovascular embolization is feasible although its safety and efficacy need to be further observed.