BACKGROUND:Majority of patients appeared different degrees of hip joint bursitis and gradual y developed into femoral head necrosis in the early rehabilitation process of severe acute respiratory syndrome. OBJECTIVE:To analyze various causes of the severe acute respiratory syndrome sequela, and to review the treatment method of femoral head necrosis. METHODS:The PubMed database, China Journal Ful-text database (CNKI), VIP database and Wanfang database were retrieved by the first author with computer for the related articles from January 1997 to August 2012. The key words of“infectious atypical pneumonia, sequela, femoral head necrosis, bone ischemia, etiology, infectious atypical pneumonia virus, conservative treatment, operation treatment, total hip replacement”in English and Chinese were put in the title and abstract to search articles. A total of 872 articles were screened out after primary retrieval, and eventual y 56 articles were included for review. RESULTS AND CONCLUSION:Severe acute respiratory syndrome sequela, femoral head necrosis, was related with the dose and duration of hormone, patient’s sensitivity to hormone, using method, the secretion of leptin and bone calcitonin, and also infectious atypical pneumonia virus. The femoral head necrosis caused by the above factors can be treated with conservative treatment to slow down the process of femoral head necrosis and delay prosthesis replacement. Eventual y, most of the patients wil receive surgical method. For the treatment of advanced severe acute respiratory syndrome sequelae femoral head necrosis, prosthesis replacement can get the best effect.

The clival region refers to the skull base between dorsum sellae and anterior border of foramen magnum. It is located in central area of skull base and is in close proximity to pons, medulla oblongata, basilar artery and other crucial intracranial structures. Although there are various microsurgical approaches using craniotomy to reach this region, there are still a lot of difficulty in exposure of clivus. With the increasing development in extended endoscopic endonasal approach, a new route to clivus, as well as meticulous endoscopic anatomy studies is emerging. This article reviewed related researches progress of the detailed anatomical studies from endoscopic perspective.
Cranial Fossa, Posterior ; anatomy & histology ; Craniotomy ; Endoscopy ; methods ; Humans ; Nasal Surgical Procedures ; methods ; Nose ; anatomy & histology ; Skull Base ; anatomy & histology

BACKGROUND: Learning memory disorder is one of the major manifestations of aging. The model of aging induced by D-galactose is a commonly used animal model in recent years, and long-term D-galactose exposure may cause nerve cell morphological changes in animals.OBJETCIVE: To observe spatial learning memory behavior during Dgalactose-induced aging process in order to further explore in vivo evoked long-term potentiation in hippocampus dentate gyrus and synaptic morphological changes in hippocampal CA3 region.DESIGN: Randomized controlled observation.SETTING: Anatomical Teaching and Research Secti , Shanghai Second Medical University; Department of Physiology, Shanghai Traditional Chinese Medicine University.MATERIALS: The experiment was carried out at the Physiological Laboratory of Shanghai Traditional Chinese Medicine University between August 2000 and April 2001. Totally 22 male Wistar rats of 3-month birth age were included and randomized into normal group and D-galactose group with 11 rats in each group. D-galactose was produced by Shanghai No. 2 Chemical Reagent Factory, Morris water maze was home-made by the Institute of Geriatrics, Shanghai Traditional Chinese Medicine university.METHODS: Rats were subjected to hypodermic injection of 1 mL normal saline every day in normal group, or D-galactose of 800 mg/kg daily for 6consecutive weeks in D-galactose group. Rat spatial learning memory behavior was assessed by the latency of Morris water maze; hippocampal dentate gyrus community potentials evoked by monopulse stimulation on perforating fibers were recordedin vivo; meanwhile, the amplitude of monopulse evoked potentials was determined before and after high frequency stimulation, with the amplitude before high frequency stimulation taken as baseline. Transmission electromicroscope was applied in combination with imaging analysis to observe synaptic morphology and structure in rat hippocampal CA3 region. Water labyrinth latency was compared using the variance analysis of repetitive survey design, t-test was used to compare the differences of peak potential latency of community potentials at various time points after long-term potentiation. Moreover, inducing rate of longterm potentiation was compared by χ2-test, XY-540 type biological imaging processing system was used to analyze electromicroscopic pictures, and all available data were analyzed with t-test.MAN OUTCOME MEASURES: [1] Main outcomes: Changes of Morris water maze latency, as well as inducing rate of long-term potentiation and community potentials. [2] Secondary outcomes: Synaptic morphological and structural changes in hippocampal CA3 region.RESULTS: Totally 22 rats were enrolled in this study, with no one lost during water labyrinth test, but one rat in both normal group and D-galactose group died during electrophysiological experiment. Finally 3 rats were randomly selected from each group for electromicroscopic observation. [1]Comparison of the latency for Morris water maze: In contrast with that of normal group, latency for seeking submarine platform was obviously prolonged in D-galactose group [(14.77±10.10), (51.36±12.45) s, P ＜ 0.05].[2] Comparison of evoked potential in hippocampus dentate before high frequency stimulation: The two groups did not obviously differ in community potential amplitude and community potential latency [(1.05±0.47),(0.91±0.41) mV; (5.46±2.09), (5.38±2.26) ms; P ＞ 0.05]. [3] Inducing rate of long-term potentiation in hippocampal dentate gyrus: Compared to that of normal group, inducing rate in D-galactose group obviously reduced after high frequency stimulation (80%, 20%, χ2=7.20, P ＜ 0.01). [4] Comparison of community potential ratio at different time points after high frequency stimulation: Compared to that of normal group, it was notably reduced in D-galactose group at post-stimulation 20, 30, 60 minutes, respectively (1.104±0.196, 0.919±0.162; 1.354±0.212, 0.999±0.219; 1.236±0.174,0.875±0.311; P ＜ 0.05). [5] Comparison of synaptic struc tural parameters in hippocampal CA3 region: Compared to that of normal group, postsynaptic dense bodies became thickened in hippocampal CA3 region of D-galactose group [(40.60±18.26), (26.35±8.15) nm, P ＜ 0.05], the synapse gap increased [(17.69±6.28), (26.95±5.67) nm, P ＜ 0.05] while synaptic active zone was shortened [(265.13±76.50), (229.13±90.68) nm, P ＜ 0.05].CONCLUSION: Hypodermic injection of D-galactose does harm to rat spatial learning memory by reducing the long-term potentiation, inducing rate in rat hippocampal dentate gyrus, attenuating the increase of long-term potentiation-evoked potential amplitude, and even remarkably changing the synaptic ultrastructure in rat hippocampal CA3 region. It suggests that Dgalactose inhibits the long-term potentiation at hippocampal dentate gyrus and affects synaptic structure in hippocampal CA3 region, which is considered as the basis of spatial learning memory behavioral disorder.

Children with pediatric tumors have better prognosis and longer survival than adults, suggesting that attention should be paid to the long-term complications induced by radiotherapy. In this article, the data from more than 40 clinical studies of pediatric tumor radiotherapy published in the recent decade were retrospectively analyzed. Long-term complications of nervous system, cardio-cerebrovascular system, respiratory system, endocrine system, urinary system, reproductive system, skeletal development, long-term secondary tumors were considered and the corresponding radiation dose-volume parameters were summarized, aiming to guide radiation oncology physicians and physicists to optimize radiotherapy plans for children with pediatric tumors.

BACKGROUND:Cdh1 has been shown to express in rat hippocampus and cortex in a large number. Moreover, in vitro test demonstrated that Cdh1 expression was higher in neurons than in neural stem cel s, which possibly associated with the differentiation of neural stem cel s into neurons. However, the effects of anaphase promoting complex Cdh1 on ischemic neuronal damage remain unclear.
OBJECTIVE:To investigate the expression of Cdh1 and its downstream substrate in primary cultured neurons with oxygen-glucose deprivation. METHODS:Primary neurons from cortex of postnatal 24-hour rat pups were cultured in vitro, and identified by immunofluorescence staining. The oxygen-and glucose-deprived models were established by three gas incubator fil ed with nitrogen in sugar-free Earle’s solution. After 1 hour of hypoxia, reoxygenation was conducted. Real-time fluorescent quantitative PCR was used to detect the mRNA expression of Cdh1 and its downstream substrates Skp2, Cyclin B1 before hypoxia, 6 hours, 1, 3, 7 days after oxygen glucose deprivation. RESULTS AND CONCLUSION:After oxygen glucose deprivation, the expression of Cdh1 and Cyclin B1 in primary neurons was increased (P<0.05), while Skp2 expression was decreased (P<0.05). Above data indicated that Cdh1 expression in neurons increased after oxygen-glucose deprivation. It may degrade Skp2 and participate in hypoxic neuronal apoptosis by ubiquitination.

Objective To investigate the CT characteristics of ectopic pheochromocytoma in the abdomen.Methods The CT characteristics of 31 cases of ectopic pheochromocytoma in abdomen proved by surgery and pathology were retrospectively analyzed.The relationship between the density,cystic change,calcification,boundary,the enhancement degree and pathological types and tumor tissue components were studied.Results The tumors location was:9 cases in mesentery,8 cases adjacent to abdominal aorta(7 on the left and1 right),3 cases above the adrenal gland(2 on the right and 1 left),3 cases outside the renal hilum(1 on the right and 2 left),3 cases behind the inferior venacava,3 cases in hepatic hilum,and 2 cases in duodenal ampulla.Tumor size ranged from 2.7 cm ×2.5 cm to 18.0 cm × 11.0 cm(average 6.8 cm ×5.6 cm).CT plain scan:the CT value was 32-58 Hu for the substantial part(average 45 Hu),18 to 25 Hu for the cystic necrosis part (average 21.5 Hu).28 cases had clear boundary and tumor boundary in 3 cases was not clear.24 cases had equal density of the substantial part,7 cases had high density of the substantial part.21 had irregular low-density areas of necrosis in the mass center.8 cases had punctiform,patchy or linear calcification in the mass.Enhanced CT:CT value in arterial phase was 47-105 Hu of the substantial part(average 76 Hu),among which tortuous expansion within the enhanced vascular shadow of the tumor was found in 8 cases.CT value in venous phase was 45 to 90 Hu of the substantial part(average 65Hu),among which 7 cases had obviously decreased density in parenchymal enhancement part,19 cases slightly decreased,and 5 cases strengthened constantly.CT value in delayed phase was 42 to 70 Hu of the substantial part(average 56 Hu),among which 26 cases had less enhancement degree of the substantial part compared to that in the arterial and venous phase,and 5 cases had constant enhancement.Conclusions Ectopic pheochromocytoma in the abdomen has certain characteristic in CT.CT characteristics are correlated with pathologic types and tissue components.CT findings combined with clinical manifestation may suggest diagnosis.

BACKGROUND:Lots of bone graft materials such as autologous iliac bone, autologous rib, titanium mesh plus alograft are available in the treatment of bone defects after spinal tuberculosis debridement. OBJECTIVE: To compare the fixation effect of different kinds of bone graft materialsvia pedicle approach fixation for treatment of thoracic spinal tuberculosis. METHODS: Totaly 40 patients with thoracic spinal tuberculosis were enroled, including 18 patients accompanied with paraplegia and 15 patients accompanied with kyphosis deformity. Both of them were subjected to by standard anti-tuberculosis treatment for 2-4 weeks and consequent posterior pedicle screw fixation combined with debridement/bone grafting fusion. They were grouped by the variables of bone graft materials: autologous iliac bone, autologous rib, titanium mesh plus alograft groups. Al patients were folowed up for 24 months. The lesion healing, bone graft fusion, rehabilitation of paraplegia, correction of kyphosis and incidence of adverse reaction were observed. RESULTS AND CONCLUSION: The time of bone graft fusion in the autologous iliac bone group was shorter than that in the autologous rib and titanium mesh plus alograft groups (P < 0.05), and there was no significant difference between autologous rib and titanium mesh plus alograft groups. No adverse phenomenons such as grafts and titanium mesh faling off, fracture and displacement, nonunion and pseudarthrosis, tuberculosis recurrence were found in these three groups. After the symptomatic therapy for 3-6 months, the muscle strength of patients with paraplegia and spinal kyphosis deformity basically recovered, spinal kyphosis deformity was basically corrected. These results demonstrate that the treatment effect of autologous iliac bone is the best; however, the treatment effect of autologous rib is as good as the titanium mesh plus allograft.

ObjectiveTo investigate the expression of APC-Cdh1 protein after cerebral ischemia-reperfusion injury.Methods60 male Sprague-Dawley rats were randomly divided into Sham-operated group(SH) and ischemia-reperfusion group(IR). The rats of ischemia-reperfusion groups were induced by four-vessel occlusion (4-VO). At different times after injury, the expression of APC-Cdh1 of rat hippocampus was observed by Western blotting and immunohistochemistry.ResultsCompared with sham-operated group, the expression of Cdh1 protein significantly decreased 1 day and increased obviously 3 days, but decreased again 7 days after injury in ischemia-reperfusion group. The immuno-staining showed that APC-Cdh1 was highly cerebral cortex and hippocampus in ischemia-reperfusion group. ConclusionAPC-Cdh1 may be involved in the central nervous system injury.

Objective To investigate the epidemiological characteristics,clinical features,diagnosis,treatment and prognosis of benign tumor of the bile ducts.Methods The retrospective cross-sectional multicenter study was conducted.The clinical data of 136 patients with benign tumor of the bile ducts who were admitted to the eight hospitals between January 2007 and December 2016 were collected,including 70 in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University,19 in the First Affiliated Hospital of Zhengzhou University,15 in the First Affiliated Hospital of Xi'an Jiaotong University,11 in the First Affiliated Hospital of Dalian Medical University,7 in the Affiliated Hospital of North Sichuan Medical College,6 in the Southwest Hospital of the Third Military Medical University,4 in the Cancer Center of Sun Yat-Sen University and 4 in the Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.All the patients received laboratory and imaging examinations,and then underwent corresponding surgery when treatment planning was respectively determined by comprehensive hospitals according to clinical features and results of examinations.Surgical procedures were performed based on the results of intraoperative frozen section in rapid pathological diagnosis.Observation indicators:(1) epidemiological characteristics;(2) clinical features;(3) results of laboratory and imaging examinations;(4) treatment situations;(5) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients up to March 2017.Measurement data with normal distribution were represented as-x±s.Results (1) Epidemiological characteristics:Of 136 patients,the male to female ratio was 1.78 ∶ 1.The incidence of whole bile duct tumors was from high to low,including 52 patients with duodenal papilla adenoma,32 with extrahepatic bile duct adenoma,24 with intrahepatic biliary cystadenoma,11 with intrahepatic papillary adenoma,9 with intrahepatic bile duct epithelial tumor,7 with epithelial tumor of duodenal papilla and 1 with neuroendocrine tumor of duodenal papilla.Among 136 patients,adenomas (including cystadenoma) was detected in 108 patients,papillomas in 11 patients,intraepithelial neoplasias in 16 patients,neuroendocrine tumor in 1 patient;intrahepatic bile duct benign tumors in 44 patients and extrahepatic bile duct (including duodenal papilla) benign tumors in 92 patients.(2) Clinical features:of 44 patients with intrahepatic bile duct benign tumors,29 had abdominal pain,fever and abdominal masses,4 had jaundice,11 had no obvious clinical symptoms and were diagnosed by physical examination.Among 92 patients with extrahepatic bile duct benign tumors,76 developed obstructive jaundice,68 were accompanied by abdominal pain or colicky pain,8 were combined with pancreatitis and 2 deveIoped hemobilia,some patients were combined with multiple clinical symptoms.(3) Results of laboratory and imaging examinations:82 patients received CA19-9 test,results of 22 patients were abnormal,with a level of (148-± 126)U/mL.Ninety-seven patients received carcinoembryonic antigen (CEA) test,with a level of test of (2.7±2.0) μg/L,and a level of CEA in 1 patient was slight abnormal,with a level of 11.2 pμg/L.One hundred and thirty-six patients underwent preoperative ultrasound examinations,showing unqualified hepatic and bile duct space occupying lesions and bile duct dilatation.Ninetyfive patients underwent preoperative computed tomography (CT),80 underwent preoperative magnetic resonance imaging (MRI) or magnetic resonanced cholangio-pancreatography (MRCP),and 13 underwent preoperative endoscopic ultrasonography (EUS).Twenty-nine patients were considered for intrahepatic bile duct benign tumors;76 were diagnosed with obstructive jaundice,with uncertain benign or malignant tumors;other patients had bile duct space occupying,considering bile duct tumor (including cancer).Twelve patients with bile duct obstruction underwent ERCP,showing obstruction site and morphology.(4) Treatment situations:among 136 patients,65 underwent pancreaticoduodenectomy,17 underwent right hemihepatectomy + cholecystectomy,16 underwent cholecystectomy + hepatic left lateral lobectomy,11 underwent left hemihepatectomy + cholecystectomy,11 underwent duodenal papillary local excision+papilla reconstruction,11 underwent Roux-en-Y choledochojejunostomy anastomosis,4 underwent cholecystectomy + extrahepatic bile duct local excision + end-to-end bile duct anastomosis and 1 underwent endoscopic mucosal resection of duodenal papillary adenomna.Of 136 patients with postoperative complications,25 were complicated with pancreatic leakage,11 with bile leakage,2 with postoperative hemorrhage and 1 with hepatic failure.Two patients with pancreatic leakage died of massive hemorrhage caused by abdominal infection,1 died of hepatic failure and other patients were discharged from hospital after symptomatic treatment.(5) Follow-up situations:47 of 136 patients were followed up for 3-123 months,with a follow-up rate of 34.6％.During follow-up,2 patients undergoing duodenal papillary local excision + papilla reconstruction had canceration,and other patients had good survival.Conclusions There is a low clinical incidence of benign tumor of the bile ducts,which is more common in male than in female,and in adenomas (including cystadenoma) and papillomas.The preoperative imaging examinations or ERCP biopsy pathological examination can increase an accuracy of preoperative diagnosis.Benign tumors with high canceration rates need positive surgical treatment.

The 53rd annual meeting of the American Society of Clinical Oncology (ASCO) was held in Chicago,United States between June 2 and 6,2017.The latest advances in biliary tract cancer research from this meeting were summarized and analyzed in this paper.The adjuvant therapy in biliary tract cancer made a breakthrough in this meeting,the findings could provide the basis for a new standard of changing the current management model in the disease.The precision medicine and targeted therapy will be the development direction in the future.Doctors should attach great importance to the adjuvant and comprehensive therapy in biliary tract cancer and initiate high level multi-center clinical trials to improve the overall the diagnostic and treatment levels of biliary tract cancer.