Malignant tumor is an individual disease that caused by gene mutation and disorder of protein expression.The abnormity of mammalian target of rapamycin (mTOR) signaling pathways is closely related to the tumors,and its main biological function is the regulation of protein synthesis and vascular endothelial cell proliferation.However,the activation of mTOR can increase the expression of hypoxia-inducible factor-1 (HIF-1),maintain the acid microenvironment of tumor,promote tumor cell invasion and metastasis,and affect prognosis of tumor.At present,targeted therapy with mTOR and HIF-1 for new targets and gene therapy have become hot points.

Objective To assess the efficacy of using the Ilizarov bone transport combined with open bone grafting and vacuum sealing drainage (VSD) to treat infected tibial bone defect.Methods A retrospective case series study was made on 8 patients sustaining posttraumatic infectious tibial bone defect treated between March 2010 and May 2015.There were 7 male and 1 female patients between 22 and 51 years (mean,39.4 years).All patients underwent radical resection of the infected/necrotic bone and debridement of the soft tissue.Length of bone defects after debridement averaged 8 cm (range,3.5-13.5 cm) and wound size averaged 4.8 cm ×2.5 cm (range,2.3 cm× 1.1 cm-8.5 cm ×6.0 cm).Stabilization was finished with Ilizarov circular external frame in all patients.Six patients were candidates for single-or double-level bone transport,and the cancellous bone autograft was placed openly within the butterfly defect after docking.Other 2 patients were treated with one-stage shortening of the fracture ends and open cancellous bone grafting,and the bone lengthening was performed.Then the grafted wounds were covered by VSD.Data were recorded including the bone transport or lengthening time,wound healing time,union time of docking sites,consolidation time of regenerate zones,external fixation time and external fixation index.Bone results and functional results were evaluated according to the criteria given by association for the study and application of the method of Ilizarov (ASAMI).Results Duration of follow-up was 10.2-36.4 months (mean,12.2 months).All the wounds achieved successful healing and eradication of infection.Mean bone transport time was 50 days (range,30-69 days).Seven patients showed selfhealing wounds,and mean healing time was 3.4 months (range,1.2-6 months).One patient experienced wound closure by skin grafting.Union and consolidation were achieved in all docking sites and regenerate zones.Mean union time of docking sites after bone grafting was 6.8 months (range,5.3-10 months).Mean consolidation time of regenerate zones was 6.2 months (range,4.8-8.5 months).Mean external fixation time was 8.6 months (range,6.5-11.5 months) with a mean external fixation index of 1.2 months/cm(range,0.7-1.9 months/cm).According to the criterion of ASAMI,bony results were excellent in 7 patients and poor in 1 patient,and functional results were excellent in 4 patients and good in 4 patients.Conclusion Ilizarov bone transport technique combined with open bone grafting and VSD for infectious tibial bone defect can accelerate bone union and wound healing at docking sites and reduce external fixation time.

Objective To discuss the operative methods,clinical effect and safety of endovascular stenting in treatment of upra-arch extra intracranial artery stenosis.Methods Symptomatic carotid artery stenosis ＞ 50％,or no symptomatic stenosis ＞ 75％ with upra-arch extra intracranial artery stenosis patients were treated by endovascular stenting,of all patients,85 cases with carotid artery stenosis,37 cases with vertebral artery stenosis,6 cases with subclavian artery stenosis.Results One hundred and twenty-eight patients were treated with 130 vessel,used 131 stents,59 patients used vascular protection,the achievement rate of stent implantation was 100.00％.The degree of stenosis were significantly improved,the degree of stenosis from (87.65 ± 8.70)％ to (14.28 ± 4.87)％.Twenty-six patients appeared transient decline in blood pressure and heart rate,31 patients appeared persistent hypotension and decrease in heart rate.One patient (no using of vascular protection) appeared obhteration in ipsilateral middle cerebral artery,the artery was recanalization after thrombolysis treatment.The rest of 127 patients did not appear intraoperative vascular embolization complications.Eighteen patients appeared perioperative perfusion in transition,1 case happened cerebral hemorrhage (＜ 10 ml).Postoperative symptoms were improved significantly.Followed up for 6-36 months,84 patients had not restenosis in stent,1 patient had symptomless restenosis (＜ 50％).In 37 patients with vertebral artery stenosis,3 patients again appeared ischemia symptoms in postoperative 1 year,digital subtraction angiography (DSA) showed restenosis in stent,the patient was again given endovascular stenting,the symptoms disappeared.Conclusion As long as the correct choice of indications and perioperative treatment properly,the endovascular stenting in treatment of upra-arch extra intracranial artery stenosis has good clinical effect and high security.

Objective To investigate the disease menu of acupuncture and moxibustion therapy grade classification considerations of herpes zoster, and to provide a routine analysis flowsheet to other diseases’ classification. Methods Being subject to the control group for classification and based on the five point classification of evidence-based medicine for evaluation, the internalized documents were evaluated according to the sequence from high level to low. If the conclusion supported by the higher level documents, other lower level documents’ results were given up. Results Acupuncture is effective and safe to herpes zoster, comparing with the international accepted curative drugs such as aciclovir tablet and so on, it is much more effective to relieve pain and make it quickly absorbed and cured. Conclusions Herpes Zostor drugs is the first grade disease menu of acupuncture and moxibustion therapy.

Objective:To observe the efficacy of rosuvastatin combined with the conventional treatment in the patients with acute cerebral infarction (ACI) and the influence on the serum levels of MMp2, vasostatin-2 and sICAM-1.Methods:Totally 136 patients with ACI were randomly divided into the routine treatment group and the rosuvastatin group with 68 ones in each .The patients in the routine treatment group were treated with the conventional treatment , and those in the rosuvastatin group were treated with rosuvastatin additionally.The treatment course was 15 days.The efficacy, adverse drug reactions and the changes of MMp 2, vasostatin-2 and sI-CAM-1 in the two groups were compared .Results:The effective rate was 92.65%in rosuvastatin group and that was 77.94%in the routine treatment group, and the difference was statistically significant (P<0.05).After the treatment, the levels of MMp2, vasosta-tin-2 and sICAM-1 for the mild, medium and severe types in the two groups were significantly decreased when compared with those be -fore the treatment (P<0.05), and the decrease for the same type in rosuvastatin group was more notable than that in the routine treat -ment group (P<0.05).The indices for different subgroups with various infarcts in rosuvastatin group were all lower than those for the same subgroup in the routine treatment group (P<0.05).The incidence of adverse drug reactions (ADR) in two group was no signifi-cant difference (P>0.05).Conclusion:Rosuvastatin used in the patients with ACI has better clinical efficacy than the routine treat-ment, which can reduce the levels of MMp 2, vasostatin-2 and sICAM-1 and is worthy of clinical promotion .

BACKGROUND:Comeal graft endothelial cell density may decline spontaneously at a super-physiological speed after penetrating keratoplasty (PKP),even if no corneal rejection happens,and this is chronic corneal allograff dysfunction (CCAD).OBJECTIVE:To investigate the effects of topical corticosteroid treatment on chronic corneal allograft dysfunction after PKP.DESIGN,TIME AND SETTING:A controlled clinical analysis was performed at the Department of Ophthalmology,Tongji Hospital,Tongji University from May 2004 to May 2009.PARTICIPANTS:A total of 54 patients (eyes) who underwent PKP were included in this study.METHODS:Tobramycin-dexamethasone eyedrops was applied 6 times per day as an initial dosage and tapered during 4 months.Thereafter,drug withdrawal group and long term group were randomly divided.Treatments were ceased in the drug withdrawal group but were continued in the long-term group with a dosage of twice per day till 12 months after surgery.MAIN OUTCOME MEASURES:Corneal graft endothelial cell density was followed up.The mean follow up pedod was 3.12±0.28years.RESULTS:The corneal graft endothelial cell density of drug withdrawal and long term groups was dramatically declined within 36 months after PKP.At every time point,the endothelial cell density was significantly decreased compared to the last follow up (all P＜0.01 ).The endothelial cell density was decreased from (2 428±2.11) cells/mm~2 and (2 791±2.29) cells/mm~2 to (1 424±124) cells/mm~2 and (1 614±114) cells/mm~2 in the drug withdrawal and long-term groups,respectively.There was significant difference in endothelial cell density between the two groups no matter prior to surgery or at each time points after surgery,but the declination trends of two groups were basically the same,indicating that graft loss of endothelial cell density was not impacted by topical corticosteroid treatment after PKP (P＞0.05).CONCLUSION:Chronic corneal allograft dysfunction after PKP is independent of topical corticosteroid treatment.

Objective To investigate the expression of anionic site in adriamycin-induced nephropathy (AN) rats, and to further explore the effects of Qufengtongluo Recipe on charge barrier in glomerulus in AN rats. Methods Adriamycin nephropathy was induced by a single tail intravenous injection of adriamycin. Totally 80 rats were randomly divided into normal control group and nephropathy model group. Three weeks later, the nephropathy model was established, and 50 AN rats were randomly divided into five groups: nephropathy model group (B, n=10), Qufeng group (C, n=10), prednisone and Qufeng group (D, n=10), prednisone group (E, n=10) and benazepri group (F, n=10), and they were treated respectively. With treatment being given respectively, renal tissue samples in each group were collected at week 3 and 7, respectively. The ultrastructure and expression of anionic site were examined by electron microscope observation. Results ① After adriamycin injection, a significant increase of the 24-hour urinary protein was observed at week 3 (P<0.01). In AN rats, serum albumin was decreased (P<0.01) while serum TCH and TG were increased (P<0.01). ② In AN rats the diffuse fusion and effacement of foot processes and decrease of anionic sites in GBM were observed at week 3. ③ At week 7, the average intensity of AS dramatically increased in C and E groups (P<0.01) compared with that in nephropathy model group. Conclusion The abnormal expression of AS is the important mechanism that leads to the occurrence and development of proteinuria in AN rats. It is possible that Qufengtongluo Recipe has effects on nephrotic syndrome through altering the charge barrier in GBM in glomerulus.

Objective To investigate the expression of nephrin mRNA in adriamycin-induced nephropathy (AN) in rats, and to explore the effect of Qufengtongluo recipe on proteinuria in AN rats and on the expression of nephrin mRNA. Methods Adriamycin nephropathy was induced by a single tail intravenous injection of adriamycin. We randomly divided 140 rats into a normal control group (n=32) and a nephropathy model group (n=108). Three weeks later, 90 AN rats were randomly divided into 5 groups: a model group, a qufeng group, a qufeng and prednisone group, a prednisone group, and a benazepri group (18 rats in each group). They were treated respectively, and renal tissue samples were collected at week 0, 3, 5, and 7, respectively. The distribution and expression of nephrin mRNA were examined by indirect immunofluorescence and semi-quantity RT-PCR. Results In the AN rats, the diffuse fusion and effacement of foot processes were observed at week 3. The fluorescence intensity of nephrin and the expression of nephrin mRNA significantly increased in the qufeng group and the prednisone group compared with the model group at the week 7 (P＜0.01).Conclusion Abnormal expression of nephrin is the important molecular mechanism that leads to the occurrence and development of proteinuria in AN rats. Qufengtongluo recipe has effect on nephrotic syndrome through altering the expression and distribution of nephrin in glomerulus.

Objective To investigate the changes of uveoscleral pathway by an I1 receptor agonist,moxonidine,and with pretreatment of antagonists topical administration,and to study the mechanism that moxonidine improves uveoscleral outflow.Methods Moxonidine was administered unilaterally and topically to rabbits and with pretreatment of the antagonists,namely,prazosin,yohimbine and efaroxan.FITC-BSA,a tracer agent,was injected into the anterior chamber after moxonidine treatment or with pretreatment of the antagonists.Frozen sections were undertaken at different time points between 2 to 10 h.Fluorescence intensity was observed in the sites of uveoscleral pathway in the sections by fluorescence microscopy.Results Bilateral fluorescence intensity treated with moxonidine was more intense than that with placebo,and the most intense regions of fluorescence were ciliary body and superchoroidal space.Fluorescence intensity by prazosin pretreatment was not significantly different compared to that by moxonidine,while yohimbine and efaroxan pretreatment decreased the intensity compared with moxonidine(P

Objective To appraise therapeutic effects of tubeimoside on herpes simplex keratitis of rabbits. Methods HSV-1 (SM_(44) strain) is recovered on monolayers of BHK-21 cell cultures, then rabbit model of HSK was established after inoculation. After 0.2g/L Tu topically given, all eyes are examined by using slit-lamp-microscopy, and corneal samples were observed for ocular changes under transmission and scanning electromicroscope. (Results )Differences were significant in the three groups of corneal involvement scores. 0.2g/L Tu can obviously reduce corneal involvement area, and can also help to rehabilitate affected corneal epithelial cells. Conclusion Tu agent is able to cure experimental HSK to a certain degree, however, is less effective on HSK than acyclovir.