BACKGROUND:Orthodontic treatment is a mechanical force for tooth to cause the remodeling of periodontal tissue, produced by the tooth movement. The main aspect of orthodontic periodontal tissue remodeling is the alveolar bone. Insulin-like growth factor is an important factor in the remodeling of periodontal tissue, which plays an important role in the growth, differentiation and growth of the cels. OBJECTIVE:To review the role of insulin-like growth factors in periodontal tissue remodeling. METHODS: A computer-based retrieval of PubMed, CNKI and Guizhou Province Digital Library Database was performed to search articles related to the role of insulin-like growth factors in periodontal tissue remodeling. The keywords were “insulin-like growth factor; periodontal tissue; remodeling” in English and Chinese, respectively. RESULTS AND CONCLUSION: Insulin like growth factor belongs to the insulin family, a kind of peptides, which can promote the migration, proliferation, differentiation, colagen and matrix synthesis and alkaline phosphatase activity of osteoblasts, fibroblasts and mesenchymal cels in the periodontal ligament. It also plays an important role in the repair of injury. During orthodontic treatment, the use of suitable orthodontic force combined with insulin-like growth factor can promote periodontal tissue remodeling, accelerate the orthodontic tooth movement and shorten the treatment time for patients.

Objective To investigate the influence of gonadotropin releasing hormone agonist (GnRH-a) on the expression mRNA of nerve growth factor (NGF) and its receptors (TrkA and P75NTR) in normal and eutopic endometrial stromal cells (ESC).Methods From January to April 2009,3 patients with endometriosis undergoing surgery in Peking Union Medical College Hospital were obtained eutopic endometrium as study group matched with eutopic endometrium from 3 parents with teratoma as control group.ESC were incubated with different concentration of GnRH-a (0,5 × 10-11,5 × 10-10,5 × 10-9,5 ×10-8,5 × 10-7 g/ml).The expression of mRNA of NGF,TrkA and P75NTR were measured by real-time-PCR.Results At concentration of 0 g/ml,the levels of NGF,TrkA and P75NTR mRNA in ESC were 6.32,8.55,8.08 in study group,which were significantly higher than 0.94,0.67,1.08 in control group (P ＜0.05).Treated by the following concentration of GnRH-a (5 × 10-11,5 × 10-10,5 × 10-9,5 × 10-8,5 ×10-7 g/ml),the median expression of NGF,TrkA and P75NTR mRNA was 1.00,0.96,1.05; 1.09,0.82,1.27 ; 1.04,0.52,0.81 ; 1.00,0.55,0.64; 0.78,0.49,1.02 in study group.Compared with the expressions of those untreated by GnRH-a in study group, they showed significantly lower trends (P ＜0.05).In control group,the median expression of NGF,TrkA and P75NTR mRNA was 0.98,0.37,0.92; 0.70,0.45,1.15; 1.55,0.80,1.35; 1.09,0.41,1.35; 0.90,0.82,1.18.Compared with the expressions of those untreated by GnRH-a in control group,there were no statistically differences ( P ＞0.05).And treated by the same concentration of GnRH-a,the expressions of NGF,TrkA and P75NTR mRNA did not show statistically difference between the two groups ( P ＞ 0.05 ).Conclusion The expression of NGF.TrkA and P75NTR mRNA were suppressed by GnRH-a.

The reasons why the relationships between doctors and patients hasn't advanced to a full and true harmonious stage in our country are multiple.From the legal point of view,the research on the important legal issues of doctor-patient relationship is deficient.The law regulating the relationship is hysteretic and even lacking.The system settling the doctor-patient conflict is distempered and imperfect.Both the doctors' and patients' legal knowledge and consciousness are inadequate.Therefore,it is necessary to discuss the legal measures from the four aspects to construct a harmonious medical service system.

BACKGROUND:Radiation-induced brain injury has recently become an increasing area of research, in particular in animal experimental studies. Domestic and international researches show that there have been no uniform scanning parameters used for examination of animal models of radiation-induced brain injury by magnetic resonance imaging. In this study, we performed magnetic resonance imaging in rabbits to determine related sequence parameters. OBJECTIVE:To establish the New Zealand rabbit models of radiation-induced brain injury, and obtain the brain magnetic resonance images of rabbits using LOOP7 coil, so as to provide experimental evidence for diagnosis of radiation-induced brain injury by magenetic resonance imaging. METHODS:Each of T2-weighted imaging, diffusion tensor imaging, magnetic resonance spectroscopy and magnetic susceptibility-weighted imaging were performed several times through the use of LOOP7 coil, to determine the optimal scanning parameters for each sequence. Rabbit models of radiation-induced brain injury were established and then their right hemispheres were irradiated using 6 MV X-rays at a single dose of 40, 80 and 120 Gy. The daily performance and dynamic magnetic resonance signs of rabbits were observed. The brain tissue was taken for pathological examination once abnormal magnetic resonance findings were observed or after 20 weeks of folow-up. RESULTS AND CONCLUSION:Only one rabbit model in the 40 Gy group had subdural hemorrhage. In the 80 Gy group, abnormal T2-weight imaging signals were observed in al rabbit models, which were pathologicaly confirmed as scattered degenerated neurons and infiltrated neutrophils. The abnormal signals that gradualy expanded over time were seen in rabbits from the 120 Gy group by magnetic resonance imaging and were pathologicaly confirmed as radiation-induced brain injury loci. The results confirm that establishing rat models of radiation-induced brain injury using radiation therapy system can better simulate the pathological process of radiation-induced brain injury; moreover, this model can be applied to receive routine magnetic resonance examination with LOOP7 coil.

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.

Objective To investigate clinicopathological characteristics of recurrent endometriosis and outcomes of secondary surgery.Methods From Jan.2003 to Dec.2008,69 cases with recurrent endometriosis operated by the same senior gynecologist in Peking Union Medical College Hospital were studied retrospectively in order to summarize clinicopathological characteristics and clinical outcomes.In prior surgery,both ovaries were involved in 29 cases (42％,29/69),and unilateral ovarian endometriomas were found in 40 cases ( 58％,40/69),including 19 cases (48％,19/40) with left lesions and 21 cases (52％,21/40) with right lesions.After first surgery,57 cases presented recurrent pelvic cystic masses and 12 cases presented moderate to severe pain without pelvic mass.Results The median recurrence interval was 38 ( 1 - 144) months.Among 57 cases with recurrent pelvic masses,bilateral ovarian endometiomas recurred in 24 cases at median recurrence interval of 31 months.Unilateral ovarian endometrioma recurred in 33 cases at recurrence interval of 39 months.There was no significant different recurrence period between blilateral and unilateral recurrent ovarian mass ( P =0.452).The recurrent rate of left and right side ovarian lesion was 77％ (37/48) and 68％ (34/50 cases),respectively,which did not reach statistical difference (P=0.396).Among 12 recurrent cases with pure pelvic pain,10 cases were founded combined with adenomyosis ( AM),of which 4 cases had deep infiltrated endometriosis (DIE).Compared with the 40 cases of simple ovarian endometriomas,29 cases complicated by DIE and (or) AM had longer operation time (75.1 min vs.49.9 min,P=0.017) and more blood loss (114.9 ml vs.38.4 ml,P＜0.05).In those 69 recurrent endometriosis patients,the median period of following-up was 32 months (3 months to 8 years).Six cases showed recurrent disease again at median recurrence interval of 3 years ( 6 months 6 years).Thirty-eight cases had expecting childbearing,however,only 4 women underwent childbirth.Conclusions The rate of clinical diagnosis of recurrent endometriosis is quite high.Pain is mostly associated with AM.The major difficulty and challenge of secondary surgery was ovarian endometrioma combined with DIE or AM.Prognosis of recurrent endometriosis is not optimistic after secondary surgery.

OBJECTIVE: To study the pharmacological activities and toxicity of the crude alkaloids of Toddalia asiatica and to provide pharmacological data for the further development of this herbal medicine. METHODS: We observed the anti-inflammatory effects of the crude alkaloids of Toddalia asiatica, using xylol and agra to induce the turgidness and sodium carboxymethyl cellulose (CMC-Na) to induce leucocyte strolling in the rats. The analgesic effects were observed by body-distortion methods. The effects of alkaloids of Toddalia asiatica on hepatic function were observed by testing the contents of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum and calculating the liver index. The LD 50 and 95% creditability were calculated with developed Karber Method. RESULTS: The administration of alkaloids of Toddalia asiatica had the function of inhibiting the auricle swelling caused by xylol and joint swelling caused by agar and leucocyte migration caused by CMC-Na, decreasing the body-distortion of the rats. After two weeks administration, the contents of ALT and AST showed that there was no obvious difference between administered group and control group. The LD50 of the crude alkaloids of Toddalia asiatica was 1.622 g/kg and the 95% creditability was 1.29-2.03 g/kg. CONCLUSION: Toddalia asiatica has anti-inflammatory and analgesic effects, and there is no injury to the liver after long-term administration in rats.

Objective To investigate the relationship between the distribution of nerve fibers in multiple endometriosis lesions and pelvic pain.MethodsFrom Sept.2007 to Sept.2008, 120 endometriosis patients treated in Peking Union Hospital were enrolled in this study, which including 19 cases with stage Ⅰ , 29 cases with stage Ⅱ , 44 cases with stage Ⅲ and 28 cases with stage Ⅳ.The pain symptom was evaluated by visual analogue scales(VAS) score and nerve fibers in multiple endometriosis lesions were detected by immunohistochemical staining.Results The number of nerve fibers in multiple endometriosis lesions were (29.74 ± 17.33)/mm~2 in uterosacral ligament, (24.53 ± 13.34)/mm~2 in vaginal septum, (17.09 ± 10.09)/mm~2 in uterus rectum crux, (6.77 ± 4.21)/mm~2 in peritoneal endometriosis lesions, (0.07 ± 0.25)/mm~2 in endometriosis ovarian cyst wall.The number of nerve fibers in uterosacral ligament was mostly correlated with the degree of pain (r = 0.56).The nerve fibers of uterus rectum crux and vaginalseptum were correlated with defecation pain (r = 0.58 and 0.41) and dyspareunia (r = 0.82 and 0.67),which were significantly higher than those in endometriosis leision in peritoneum and ovary.There was no significant different number of nerve fibers among different stage disease (P > 0.05).Conclusion There was significantly different distribution of nerve fibers in multiple endometriosis lesions, which was correlated with dysmenorrhea, anus pain, dyspareunia and chronic pelvic pain, not with clinical staging.

Objective To investigate the characteristics of the anatomical distribution of posterior deeply infiltrating endometriosis (PDIE) lesions, pain symptoms and effects of laparoscopic surgery.Methods Clinical data of 176 PDIE patients with laparescopically diagnosed and histologically confirmed were analyzed and compared with data of 179 cases with non-PDIE. According to the invasion of rectum or vaginal fomix, 176 PDIE cases were divided into three groups: simple (144 cases), fornix (18 cases) or rectum group (14 cases). Results Compared with the non-PDIE patients, the risk of pain symptoms in PDIE patients were significantly increased, OR for dysmenorrhea, chronic pelvic pain, deep dyspareunia,dyschezia were 6.73 (95% CI, 3.66-12.40), 1.90 (95% CI, 1.17-3.05), 3.09 (95% CI, 1.94-4. 92) and 4.90 (95% CI, 2.07-8.11), respectively (all P < 0.05). The highest incidence of dyschezia was observed in rectum group (50. 0%, P <0.05), while deep dyspareunia in fornix group (72.2%, P < 0.05). The longest operative duration (82±31) minutes and the postoperative hospitalization (7.7±2.1) days were observed in rectum group (P <0.01). The median pain relief time was 56 months in the patients with complete excision of PDIE lesions, which was significantly longer than that in patients with incomplete excision (25 months, P <0.01). Multivariate analysis demonstrated that only incomplete excision of PDIE lesions was the risk factor for shorter pain relief time (P<0.05). Conclusion Conservative laparoscopic surgery may effectively relieve pelvic pain symptoms in patients with PDIE, while incomplete excision of PDIE lesions was the only significant predictor of shorter pain relief time.

Objective To study the relationship between the clinic-pathological features and pain symptoms in patients with endometriotic cyst(EM).Methods The medical data of symptoms,laparoscopy and pathology examination in 416 patients with endometriosis were studied retrospectively.All cases were divided into two groups on the existence of ovarian endometrioma,including 338 patients in cyst group and 78 cases in non-cyst group.The relationship between clinical symptoms and location and type of endometrioma was studied.Results(1)Serum CA125 level:the level of CA125 were(61 ± 39)kU/L in cyst group(28 ± 24)kU/L in non-cyst group,which reached statistical difference(P ＜ 0.01).(2)Pathological features:among 338 cases,34.0％ of cyst were on left side(115/338),26.3％ were right side(89/338),and 39.6％ were on both side(134/338).And 95.8％(324/338)of cases were combined with the other type of endometriosis,which were 48.5％(164/338)with peritoneal endometriosis,47.3％(160/338)with deep infiltrating endometriosis(DIE).In cystic patients,the incidences of endometriosis lesion were 13.9％(47/338)on the uterine surface,38.5％(130/338)on obstruction of cul-de sac,40.5％ (137/338)on utero-sacral ligament of DIE,which were significantly higher than 5.1％,(4/78),9.0％ (7/78)and 28.2％(22/78)in noncyst group.(3)Pain symptom:the incidence and degree of dysmenorrhea and dyschezia had no statistical difference between two groups(P ＞ 0.05),and the incidence of chronic pelvic pain(CPP)of 24.6％(83/338)and dyspareunia of 29.9％(101/338)in the cyst group were significantly lower than 35.9％(28/78)and 44.9％(35/78)in non-cyst group(P ＜ 0.05).The incidence of dysmenorrheal was 85.1％(114/134)in cases with bilateral cyst,which was higher than 74.0％(151/204)in cases with single cyst.The incidence of dysmenorrheal and dyschezia in moderatesevere adhesion was 89.0％(138/155)and 18.7％(29/155),which was significantly higher than 68.8％ (126/183)and 8.2％(15/183)in mild adhesion.In the patients cyst existed with DIE,the risk of dysmenorrheal,CPP,dyspareunia,and dyschezia were obviously raised(OR respectively was 5.17,3.01,3.05,2.75).Conclusions The endometriotic cyst often co-exists with other type of endometriotic lesions.Ovarian endometrioma was associated with lesion localized on uterine surface,cul-de-sac,sacrum ligament.The risk of all the pain symptoms would be raised when the endometriotic cyst co-exit with the DIE lesions.So the treatment for DIE lesions was as same important as the endometriotic lesions in order to relieve pain symptoms and delay the relapse.